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Yuzkan S, Hasimoglu O, Balsak S, Mutlu S, Karagulle M, Kose F, Altinkaya A, Tugcu B, Kocak B. Utility of diffusion tensor imaging and generalized q-sampling imaging for predicting short-term clinical effect of deep brain stimulation in Parkinson's disease. Acta Neurochir (Wien) 2024; 166:217. [PMID: 38748304 PMCID: PMC11096246 DOI: 10.1007/s00701-024-06096-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE To assess whether diffusion tensor imaging (DTI) and generalized q-sampling imaging (GQI) metrics could preoperatively predict the clinical outcome of deep brain stimulation (DBS) in patients with Parkinson's disease (PD). METHODS In this single-center retrospective study, from September 2021 to March 2023, preoperative DTI and GQI examinations of 44 patients who underwent DBS surgery, were analyzed. To evaluate motor functions, the Unified Parkinson's Disease Rating Scale (UPDRS) during on- and off-medication and Parkinson's Disease Questionnaire-39 (PDQ-39) scales were used before and three months after DBS surgery. The study population was divided into two groups according to the improvement rate of scales: ≥ 50% and < 50%. Five target regions, reported to be affected in PD, were investigated. The parameters having statistically significant difference were subjected to a receiver operating characteristic (ROC) analysis. RESULTS Quantitative anisotropy (qa) values from globus pallidus externus, globus pallidus internus (qa_Gpi), and substantia nigra exhibited significant distributional difference between groups in terms of the improvement rate of UPDRS-3 scale during on-medication (p = 0.003, p = 0.0003, and p = 0.0008, respectively). In ROC analysis, the best parameter in predicting DBS response included qa_Gpi with a cut-off value of 0.01370 achieved an area under the ROC curve, accuracy, sensitivity, and specificity of 0.810, 73%, 62.5%, and 85%, respectively. Optimal cut-off values of ≥ 0.01864 and ≤ 0.01162 yielded a sensitivity and specificity of 100%, respectively. CONCLUSION The imaging parameters acquired from GQI, particularly qa_Gpi, may have the ability to non-invasively predict the clinical outcome of DBS surgery.
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Affiliation(s)
| | - Ozan Hasimoglu
- Department of Neurosurgery, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Serdar Balsak
- Department of Radiology, Bezmialem Vakif University Hospital, Istanbul, Turkey
| | - Samet Mutlu
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Mehmet Karagulle
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Fadime Kose
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey
| | - Ayca Altinkaya
- Department of Neurosurgery, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Bekir Tugcu
- Department of Neurosurgery, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Burak Kocak
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, 34480, Turkey.
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Hwang KS, Langley J, Tripathi R, Hu XP, Huddleston DE. In vivo detection of substantia nigra and locus coeruleus volume loss in Parkinson's disease using neuromelanin-sensitive MRI: Replication in two cohorts. PLoS One 2023; 18:e0282684. [PMID: 37053195 PMCID: PMC10101455 DOI: 10.1371/journal.pone.0282684] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/20/2023] [Indexed: 04/14/2023] Open
Abstract
Patients with Parkinson's disease undergo a loss of melanized neurons in substantia nigra pars compacta and locus coeruleus. Very few studies have assessed substantia nigra pars compacta and locus coeruleus pathology in Parkinson's disease simultaneously with magnetic resonance imaging (MRI). Neuromelanin-sensitive MRI measures of substantia nigra pars compacta and locus coeruleus volume based on explicit magnetization transfer contrast have been shown to have high scan-rescan reproducibility in controls, but no study has replicated detection of Parkinson's disease-associated volume loss in substantia nigra pars compacta and locus coeruleus in multiple cohorts with the same methodology. Two separate cohorts of Parkinson's disease patients and controls were recruited from the Emory Movement Disorders Clinic and scanned on two different MRI scanners. In cohort 1, imaging data from 19 controls and 22 Parkinson's disease patients were acquired with a Siemens Trio 3 Tesla scanner using a 2D gradient echo sequence with magnetization transfer preparation pulse. Cohort 2 consisted of 33 controls and 39 Parkinson's disease patients who were scanned on a Siemens Prisma 3 Tesla scanner with a similar imaging protocol. Locus coeruleus and substantia nigra pars compacta volumes were segmented in both cohorts. Substantia nigra pars compacta volume (Cohort 1: p = 0.0148; Cohort 2: p = 0.0011) and locus coeruleus volume (Cohort 1: p = 0.0412; Cohort 2: p = 0.0056) were significantly reduced in the Parkinson's disease group as compared to controls in both cohorts. This imaging approach robustly detects Parkinson's disease effects on these structures, indicating that it is a promising marker for neurodegenerative neuromelanin loss.
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Affiliation(s)
- Kristy S Hwang
- Department of Neurosciences, University of California San Diego, San Diego, California, United States of America
| | - Jason Langley
- Center for Advanced Neuroimaging, University of California Riverside, Riverside, California, United States of America
| | - Richa Tripathi
- Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, United States of America
| | - Xiaoping P Hu
- Center for Advanced Neuroimaging, University of California Riverside, Riverside, California, United States of America
- Department of Bioengineering, University of California Riverside, Riverside, California, United States of America
| | - Daniel E Huddleston
- Department of Neurology, Emory University,Atlanta, Georgia, United States of America
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Baagil H, Hohenfeld C, Habel U, Eickhoff SB, Gur RE, Reetz K, Dogan I. Neural correlates of impulse control behaviors in Parkinson's disease: Analysis of multimodal imaging data. Neuroimage Clin 2023; 37:103315. [PMID: 36610308 PMCID: PMC9850204 DOI: 10.1016/j.nicl.2023.103315] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/22/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
BACKGROUND Impulse control behaviors (ICB) are frequently observed in patients with Parkinson's disease (PD) and are characterized by compulsive and repetitive behavior resulting from the inability to resist internal drives. OBJECTIVES In this study, we aimed to provide a better understanding of structural and functional brain alterations and clinical parameters related to ICB in PD patients. METHODS We utilized a dataset from the Parkinson's Progression Markers Initiative including 36 patients with ICB (PDICB+) compared to 76 without ICB (PDICB-) and 61 healthy controls (HC). Using multimodal MRI data we assessed gray matter brain volume, white matter integrity, and graph topological properties at rest. RESULTS Compared with HC, PDICB+ showed reduced gray matter volume in the bilateral superior and middle temporal gyrus and in the right middle occipital gyrus. Compared with PDICB-, PDICB+ showed volume reduction in the left anterior insula. Depression and anxiety were more prevalent in PDICB+ than in PDICB- and HC. In PDICB+, lower gray matter volume in the precentral gyrus and medial frontal cortex, and higher axial diffusivity in the superior corona radiata were related to higher depression score. Both PD groups showed disrupted functional topological network pattern within the cingulate cortex compared with HC. PDICB+ vs PDICB- displayed reduced topological network pattern in the anterior cingulate cortex, insula, and nucleus accumbens. CONCLUSIONS Our results suggest that structural alterations in the insula and abnormal topological connectivity pattern in the salience network and the nucleus accumbens may lead to impaired decision making and hypersensitivity towards reward in PDICB+. Moreover, PDICB+ are more prone to suffer from depression and anxiety.
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Affiliation(s)
- Hamzah Baagil
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich and RWTH Aachen University, Germany
| | - Christian Hohenfeld
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich and RWTH Aachen University, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA‑BRAIN, Jülich‑Aachen Research Alliance, Institute of Brain Structure-Function Relationships, Aachen, Germany
| | - Simon B Eickhoff
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany; Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Germany
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich and RWTH Aachen University, Germany.
| | - Imis Dogan
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich and RWTH Aachen University, Germany
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Estudillo-Romero A, Haegelen C, Jannin P, Baxter JSH. Voxel-based diktiometry: Combining convolutional neural networks with voxel-based analysis and its application in diffusion tensor imaging for Parkinson's disease. Hum Brain Mapp 2022; 43:4835-4851. [PMID: 35841274 PMCID: PMC9582380 DOI: 10.1002/hbm.26009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 11/11/2022] Open
Abstract
Extracting population‐wise information from medical images, specifically in the neurological domain, is crucial to better understanding disease processes and progression. This is frequently done in a whole‐brain voxel‐wise manner, in which a population of patients and healthy controls are registered to a common co‐ordinate space and a statistical test is performed on the distribution of image intensities for each location. Although this method has yielded a number of scientific insights, it is further from clinical applicability as the differences are often small and altogether do not permit for a high‐performing classifier. In this article, we take the opposite approach of using a high‐performing classifier, specifically a traditional convolutional neural network, and then extracting insights from it which can be applied in a population‐wise manner, a method we call voxel‐based diktiometry. We have applied this method to diffusion tensor imaging (DTI) analysis for Parkinson's disease (PD), using the Parkinson's Progression Markers Initiative database. By using the network sensitivity information, we can decompose what elements of the DTI contribute the most to the network's performance, drawing conclusions about diffusion biomarkers for PD that are based on metrics which are not readily expressed in the voxel‐wise approach.
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Affiliation(s)
| | - Claire Haegelen
- LTSI-INSERM UMR 1099, Université de Rennes 1, Rennes, France.,Département de Neurochirurgie, CHU Rennes, Rennes, France
| | - Pierre Jannin
- LTSI-INSERM UMR 1099, Université de Rennes 1, Rennes, France
| | - John S H Baxter
- LTSI-INSERM UMR 1099, Université de Rennes 1, Rennes, France
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5
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Structural connectivity alterations in the motor network of patients with scans without evidence of dopaminergic deficit (SWEDD). J Neurol 2022; 269:5926-5933. [PMID: 35794352 DOI: 10.1007/s00415-022-11259-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/13/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Approximatively, 10% of patients initially diagnosed with Parkinson's disease (PD) show preserved presynaptic dopaminergic function in the nigrostriatal pathway on DAT-SPECT imaging. This syndrome is not compatible with PD diagnosis, and is known as scans without evidence of dopaminergic deficit (SWEDD). OBJECTIVE To investigate structural connectivity of cerebello-subcortico-cortical networks, including the nigrostriatal pathway, in an international cohort of subjects with SWEDD compared to normal controls using probabilistic tractography. METHODS Twenty-eight patients with SWEDD and 21 age- and sex-matched healthy controls (HC) were selected from the Parkinson's Progression Markers Initiative (PPMI) database. All participants underwent whole-brain 3D T1-weighted and diffusion-weighted MRI, as well as DAT-SPECT. Probabilistic tractography was performed in network-mode between regions of the cerebello-thalamo-basal ganglia-cortical circuits, to extract the connectivity strength between pairs of nodes of the circuit, as well as volumetric and diffusion measures of each reconstructed tract. Analysis of covariance with age and sex as covariates of non-interest was performed to assess group differences. Statistical significance was set at p < 0.05 after false-discovery-rate correction for multiple comparisons. RESULTS Compared to HC, patients with SWEDD showed increased fractional anisotropy in bilateral thalamo-putamen-precentral, left nigro-putaminal and left thalamo-pallidal pathways. Furthermore, we found decreased mean streamline length in bilateral thalamo-nigro-cerebellar pathways and in the left nigro-caudate connection. CONCLUSIONS Clinical heterogeneity of SWEDD syndrome may account for involvement of different brain circuits, such as the cerebello-thalamo-cortical and the nigrostriatal pathways, characteristic of different tremulous disorders.
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Subtle anomaly detection: Application to brain MRI analysis of de novo Parkinsonian patients. Artif Intell Med 2022; 125:102251. [DOI: 10.1016/j.artmed.2022.102251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 11/26/2021] [Accepted: 01/29/2022] [Indexed: 11/17/2022]
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Langley J, Huddleston DE, Hu X. Nigral diffusivity, but not free water, correlates with iron content in Parkinson's disease. Brain Commun 2021; 3:fcab251. [PMID: 34805996 PMCID: PMC8599079 DOI: 10.1093/braincomms/fcab251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/18/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
The loss of melanized neurons in the substantia nigra pars compacta is a primary feature in Parkinson's disease. Iron deposition occurs in conjunction with this loss. Loss of nigral neurons should remove barriers for diffusion and increase diffusivity of water molecules in regions undergoing this loss. In metrics from single-compartment diffusion tensor imaging models, these changes should manifest as increases in mean diffusivity and reductions in fractional anisotropy as well as increases in the free water compartment in metrics derived from bi-compartment models. However, studies examining nigral diffusivity changes from Parkinson's disease with single-compartment models have yielded inconclusive results and emerging evidence in control subjects indicates that iron corrupts diffusivity metrics derived from single-compartment models. We aimed to examine Parkinson's disease-related changes in nigral iron and diffusion measures from single- and bi-compartment models as well as assess the effect of iron on these diffusion measures in two separate Parkinson's cohorts. Iron-sensitive data and diffusion data were analysed in two cohorts: First, a discovery cohort consisting of 71 participants (32 control participants and 39 Parkinson's disease participants) was examined. Second, an external validation cohort, obtained from the Parkinson's Progression Marker's Initiative, consisting of 110 participants (58 control participants and 52 Parkinson's disease participants) was examined. The effect of iron on diffusion measures from single- and bi-compartment models was assessed in both cohorts. Measures sensitive to the free water compartment (discovery cohort: P = 0.006; external cohort: P = 0.01) and iron content (discovery cohort: P < 0.001; validation cohort: P = 0.02) were found to increase in substantia nigra of the Parkinson's disease group in both cohorts. However, diffusion markers derived from the single-compartment model (i.e. mean diffusivity and fractional anisotropy) were not replicated across cohorts. Correlations were seen between single-compartment diffusion measures and iron markers in the discovery cohort (iron-mean diffusivity: r = -0.400, P = 0.006) and validation cohort (iron-mean diffusivity: r = -0.387, P = 0.003) but no correlation was observed between a measure from the bi-compartment model related to the free water compartment and iron markers in either cohort. In conclusion, the variability of nigral diffusion metrics derived from the single-compartment model in Parkinson's disease may be attributed to competing influences of increased iron content, which tends to drive diffusivity down, and increases in the free water compartment, which tends to drive diffusivity up. In contrast to diffusion metrics derived from the single-compartment model, no relationship was seen between iron and the free water compartment in substantia nigra.
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Affiliation(s)
- Jason Langley
- Center for Advanced Neuroimaging, University of California Riverside, Riverside, CA 92521, USA
| | | | - Xiaoping Hu
- Center for Advanced Neuroimaging, University of California Riverside, Riverside, CA 92521, USA.,Department of Bioengineering, University of California Riverside, Riverside, CA 92521, USA
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Wakasugi N, Hanakawa T. It Is Time to Study Overlapping Molecular and Circuit Pathophysiologies in Alzheimer's and Lewy Body Disease Spectra. Front Syst Neurosci 2021; 15:777706. [PMID: 34867224 PMCID: PMC8637125 DOI: 10.3389/fnsys.2021.777706] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/28/2021] [Indexed: 12/30/2022] Open
Abstract
Alzheimer's disease (AD) is the leading cause of dementia due to neurodegeneration and is characterized by extracellular senile plaques composed of amyloid β1 - 42 (Aβ) as well as intracellular neurofibrillary tangles consisting of phosphorylated tau (p-tau). Dementia with Lewy bodies constitutes a continuous spectrum with Parkinson's disease, collectively termed Lewy body disease (LBD). LBD is characterized by intracellular Lewy bodies containing α-synuclein (α-syn). The core clinical features of AD and LBD spectra are distinct, but the two spectra share common cognitive and behavioral symptoms. The accumulation of pathological proteins, which acquire pathogenicity through conformational changes, has long been investigated on a protein-by-protein basis. However, recent evidence suggests that interactions among these molecules may be critical to pathogenesis. For example, Aβ/tau promotes α-syn pathology, and α-syn modulates p-tau pathology. Furthermore, clinical evidence suggests that these interactions may explain the overlapping pathology between AD and LBD in molecular imaging and post-mortem studies. Additionally, a recent hypothesis points to a common mechanism of prion-like progression of these pathological proteins, via neural circuits, in both AD and LBD. This suggests a need for understanding connectomics and their alterations in AD and LBD from both pathological and functional perspectives. In AD, reduced connectivity in the default mode network is considered a hallmark of the disease. In LBD, previous studies have emphasized abnormalities in the basal ganglia and sensorimotor networks; however, these account for movement disorders only. Knowledge about network abnormalities common to AD and LBD is scarce because few previous neuroimaging studies investigated AD and LBD as a comprehensive cohort. In this paper, we review research on the distribution and interactions of pathological proteins in the brain in AD and LBD, after briefly summarizing their clinical and neuropsychological manifestations. We also describe the brain functional and connectivity changes following abnormal protein accumulation in AD and LBD. Finally, we argue for the necessity of neuroimaging studies that examine AD and LBD cases as a continuous spectrum especially from the proteinopathy and neurocircuitopathy viewpoints. The findings from such a unified AD and Parkinson's disease (PD) cohort study should provide a new comprehensive perspective and key data for guiding disease modification therapies targeting the pathological proteins in AD and LBD.
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Affiliation(s)
- Noritaka Wakasugi
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takashi Hanakawa
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Integrated Neuroanatomy and Neuroimaging, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Dolatshahi M, Ashraf-Ganjouei A, Wu IW, Zhang Y, Aarabi MH, Tosun D. White matter changes in drug-naïve Parkinson's disease patients with impulse control & probable REM sleep behavior disorders. J Neurol Sci 2021; 430:120032. [PMID: 34688191 DOI: 10.1016/j.jns.2021.120032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/24/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND According to epidemiological studies, Parkinson's disease (PD) patients with probable REM sleep behavior disorder (pRBD) are more prone to develop impulse control disorders (ICDs), which is shown to be present in drug-naïve PD patients, and vice versa. OBJECTIVES To investigate white-matter integrity differences, with and without comorbid pRBD and ICDs. METHODS 149 de-novo PD patients and 30 age- and gender-matched controls from the Parkinson's Progression Markers Initiative were studied. PD subjects were categorized into four groups with and without these comorbidities. We investigated the white matter integrity differences between these groups. RESULTS PDs with only ICDs manifested greater fractional anisotropy (FA) and lower mean diffusivity (MD) in ipsilateral cerebellar connections when compared to controls and to Parkinson's with both comorbid disorders. In contrast, significantly lower FA and higher MD in the ipsilateral fornix-stria-terminalis was observed in PDs with only pRBD compared to controls and to PDs without either comorbid disorder. Also, PDs with only pRBD manifested greater FA in contralateral putamen when compared to controls. CONCLUSIONS Our results suggest the presence of an underlying neural network in PDs with ICDs, particularly involving cerebellar connections, which makes the subjects susceptible to pRBD. Lower white-matter integrity in the fornix of PDs with only pRBD suggests a neuropathological pathway specific to sleep behavior disorder, independent of impulse control disorders. Greater white-matter integrity observed in PDs without comorbid ICDs, regardless of their comorbid pRBD status, might reflect compensatory mechanisms. Targeted therapies for this particular neuropathology may help prevent these comorbidities.
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Affiliation(s)
- Mahsa Dolatshahi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran; NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | | | - I-Wei Wu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Yu Zhang
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Mohammad Hadi Aarabi
- Department of Neuroscience, Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
| | - Duygu Tosun
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States.
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Hybrid PET-MRI for early detection of dopaminergic dysfunction and microstructural degradation involved in Parkinson's disease. Commun Biol 2021; 4:1162. [PMID: 34621005 PMCID: PMC8497575 DOI: 10.1038/s42003-021-02705-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/22/2021] [Indexed: 01/10/2023] Open
Abstract
Dopamine depletion and microstructural degradation underlie the neurodegenerative processes in Parkinson’s disease (PD). To explore early alterations and underlying associations of dopamine and microstructure in PD patients utilizing the hybrid positron emission tomography (PET)-magnetic resonance imaging (MRI). Twenty-five PD patients in early stages and twenty-four matched healthy controls underwent hybrid 18F-fluorodopa (DOPA) PET-diffusion tensor imaging (DTI) scanning. The striatal standardized uptake value ratio (SUVR), DTI maps (fractional anisotropy, FA; mean diffusivity, MD) in subcortical grey matter, and deterministic tractography of the nigrostriatal pathway were processed. Values in more affected (MA) side, less affected (LA) side and mean were analysed. Correlations and mediations among PET, DTI and clinical characteristics were further analysed. PD groups exhibited asymmetric pattern of dopaminergic dysfunction in putamen, impaired integrity in the microstructures (nigral FA, putaminal MD, and FA of nigrostriatal projection). On MA side, significant associations between DTI metrics (nigral FA, putaminal MD, and FA of nigrostriatal projection) and motor performance were significantly mediated by putaminal SUVR, respectively. Early asymmetric disruptions in putaminal dopamine concentrations and nigrostriatal pathway microstructure were detected using hybrid PET-MRI. The findings further implied that molecular degeneration mediates the modulation of microstructural disorganization on motor dysfunction in the early stages of PD. To explore early alterations and underlying associations of dopamine levels and microstructure in Parkinson’s Disease (PD), Shang et al use a hybrid positron emission tomography (PET)-magnetic resonance imaging (MRI) approach in early stage patients and age-matched controls. Their data implies that molecular degeneration mediates the effects of microstructural disorganization on motor dysfunction in the early stages of PD.
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Hentrich T, Wassouf Z, Ehrhardt C, Haas E, Mills JD, Aronica E, Outeiro TF, Hübener-Schmid J, Riess O, Casadei N, Schulze-Hentrich JM. Increased expression of myelin-associated genes in frontal cortex of SNCA overexpressing rats and Parkinson's disease patients. Aging (Albany NY) 2020; 12:18889-18906. [PMID: 33017301 PMCID: PMC7732335 DOI: 10.18632/aging.103935] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/01/2020] [Indexed: 01/24/2023]
Abstract
Parkinson's disease (PD) is an age-dependent neurodegenerative disorder. Besides characteristic motor symptoms, patients suffer from cognitive impairments linked to pathology in cortical areas. Due to obvious challenges in tracing the underlying molecular perturbations in human brain over time, we took advantage of a well-characterized PD rat model. Using RNA sequencing, we profiled the frontocortical transcriptome of post-mortem patient samples and aligned expression changes with perturbation patterns obtained in the model at 5 and 12 months of age reflecting a presymptomatic and symptomatic time point. Integrating cell type-specific reference data, we identified a shared expression signature between both species that pointed to oligodendrocyte-specific, myelin-associated genes. Drawing on longitudinal information from the model, their nearly identical upregulation in both species could be traced to two distinctive perturbance modes. While one mode exhibited age-independent alterations that affected genes including proteolipid protein 1 (PLP1), the other mode, impacting on genes like myelin-associated glycoprotein (MAG), was characterized by interferences of disease gene and adequate expression adaptations along aging. Our results highlight that even for a group of functionally linked genes distinct interference mechanisms may underlie disease progression that cannot be distinguished by examining the terminal point alone but instead require longitudinal interrogation of the system.
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Affiliation(s)
- Thomas Hentrich
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen 72076, Germany
| | - Zinah Wassouf
- German Center for Neurodegenerative Diseases, Göttingen 37073, Germany,Department of Experimental Neurodegeneration, Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, Göttingen 37073, Germany
| | - Christine Ehrhardt
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen 72076, Germany
| | - Eva Haas
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen 72076, Germany
| | - James D. Mills
- Department of (Neuro) Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam 1105 AZ, The Netherlands
| | - Eleonora Aronica
- Department of (Neuro) Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam 1105 AZ, The Netherlands
| | - Tiago Fleming Outeiro
- German Center for Neurodegenerative Diseases, Göttingen 37073, Germany,Department of Experimental Neurodegeneration, Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, Göttingen 37073, Germany,Max Planck Institute for Experimental Medicine, Göttingen 37073, Germany,Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle Upon Tyne NE2 4HH, UK
| | - Jeannette Hübener-Schmid
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen 72076, Germany
| | - Olaf Riess
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen 72076, Germany
| | - Nicolas Casadei
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen 72076, Germany,DFG NGS Competence Center Tübingen, Tübingen 72076, Germany
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Zhang Y, Burock MA. Diffusion Tensor Imaging in Parkinson's Disease and Parkinsonian Syndrome: A Systematic Review. Front Neurol 2020; 11:531993. [PMID: 33101169 PMCID: PMC7546271 DOI: 10.3389/fneur.2020.531993] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/18/2020] [Indexed: 12/21/2022] Open
Abstract
Diffusion tensor imaging (DTI) allows measuring fractional anisotropy and similar microstructural indices of the brain white matter. Lower than normal fractional anisotropy as well as higher than normal diffusivity is associated with loss of microstructural integrity and neurodegeneration. Previous DTI studies in Parkinson's disease (PD) have demonstrated abnormal fractional anisotropy in multiple white matter regions, particularly in the dopaminergic nuclei and dopaminergic pathways. However, DTI is not considered a diagnostic marker for the earliest Parkinson's disease since anisotropic alterations present a temporally divergent pattern during the earliest Parkinson's course. This article reviews a majority of clinically employed DTI studies in PD, and it aims to prove the utilities of DTI as a marker of diagnosing PD, correlating clinical symptomatology, tracking disease progression, and treatment effects. To address the challenge of DTI being a diagnostic marker for early PD, this article also provides a comparison of the results from a longitudinal, early stage, multicenter clinical cohort of Parkinson's research with previous publications. This review provides evidences of DTI as a promising marker for monitoring PD progression and classifying atypical PD types, and it also interprets the possible pathophysiologic processes under the complex pattern of fractional anisotropic changes in the first few years of PD. Recent technical advantages, limitations, and further research strategies of clinical DTI in PD are additionally discussed.
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Affiliation(s)
- Yu Zhang
- Department of Psychiatry, War Related Illness and Injury Study Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Marc A Burock
- Department of Psychiatry, Mainline Health, Bryn Mawr Hospital, Bryn Mawr, PA, United States
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13
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Le H, Zeng W, Zhang H, Li J, Wu X, Xie M, Yan X, Zhou M, Zhang H, Wang M, Hong G, Shen J. Mean Apparent Propagator MRI Is Better Than Conventional Diffusion Tensor Imaging for the Evaluation of Parkinson's Disease: A Prospective Pilot Study. Front Aging Neurosci 2020; 12:563595. [PMID: 33192458 PMCID: PMC7541835 DOI: 10.3389/fnagi.2020.563595] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022] Open
Abstract
Background and Purpose Mean apparent propagator (MAP) MRI is a novel diffusion imaging method to map tissue microstructure. The purpose of this study was to evaluate the diagnostic value of the MAP MRI in Parkinson’s disease (PD) in comparison with conventional diffusion tensor imaging (DTI). Methods 23 PD patients and 22 age- and gender-matched healthy controls were included. MAP MRI and DTI were performed on a 3T MR scanner with a 20-channel head coil. The MAP metrics including mean square displacement (MSD), return to the origin probability (RTOP), return to the axis probability (RTAP), and return to the plane probability (RTPP), and DTI metrics including fractional anisotropy (FA), and mean diffusivity (MD), were measured in subcortical gray matter and compared between the two groups. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic performance of all the metrics. The association between the diffusion metrics and disease severity was assessed by Pearson correlation analysis. Results For MAP MRI, the mean values of MSD in the bilateral caudate, pallidum, putamen, thalamus and substantia nigra (SN) were higher in PD patients than in healthy controls (pFDR ≤ 0.001); the mean values of the zero displacement probabilities (RTOP, RTAP, and RTPP) in the bilateral caudate, pallidum, putamen and thalamus were lower in PD patients (pFDR < 0.001). For DTI, only FA in the bilateral SN was significantly higher in PD patients than those in the controls (pFDR < 0.001). ROC analysis showed that the areas under the curves of MAP MRI metrics (MSD, RTOP, RTAP, and RTPP) in the bilateral caudate, pallidum, putamen and thalamus (range, 0.85–0.94) were greater than those of FA and MD of DTI (range, 0.55–0.69) in discriminating between PD patients and healthy controls. RTAP in the ipsilateral pallidum (r = −0.56, pFDR = 0.027), RTOP in the bilateral and contralateral putamen (r = −0.58, pFDR = 0.019; r = −0.57, pFDR = 0.024) were negatively correlated with UPDRS III motor scores. Conclusion MAP MRI outperformed the conventional DTI in the diagnosis of PD and evaluation of the disease severity.
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Affiliation(s)
- Hongbo Le
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.,Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weike Zeng
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huihong Zhang
- Food Safety and Health Research Center, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jianing Li
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Wu
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mingwei Xie
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xu Yan
- MR Scientific Marketing, Siemens Healthcare, Shanghai, China
| | - Minxiong Zhou
- College of Medical Imaging, Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Science, Shanghai, China
| | - Huiting Zhang
- MR Scientific Marketing, Siemens Healthcare, Shanghai, China
| | - Mengzhu Wang
- MR Scientific Marketing, Siemens Healthcare, Shanghai, China
| | - Guobin Hong
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Jun Shen
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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14
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Sanchez-Catasus CA, Bohnen NI, Yeh FC, D'Cruz N, Kanel P, Müller MLTM. Dopaminergic Nigrostriatal Connectivity in Early Parkinson Disease: In Vivo Neuroimaging Study of 11C-DTBZ PET Combined with Correlational Tractography. J Nucl Med 2020; 62:545-552. [PMID: 32859707 DOI: 10.2967/jnumed.120.248500] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/25/2020] [Indexed: 12/11/2022] Open
Abstract
Previous histopathologic and animal studies have shown axonal impairment and loss of connectivity of the nigrostriatal pathway in Parkinson disease (PD). However, there are conflicting reports from in vivo human studies. 11C-dihydrotetrabenazine (11C-DTBZ) is a vesicular monoamine type 2 transporter PET ligand that allows assessment of nigrostriatal presynaptic dopaminergic terminal integrity. Correlational tractography based on diffusion MRI can incorporate ligand-specific information provided by 11C-DTBZ PET into the fiber-tracking process. The purpose of this study was to assess the in vivo association between the integrity of the nigrostriatal tract (defined by correlational tractography) and the degree of striatal dopaminergic denervation based on 11C-DTBZ PET. Methods: The study involved 30 subjects with mild to moderate PD (23 men and 7 women; mean age, 66 ± 6.2 y; disease duration, 6.4 ± 4.0 y; Hoehn and Yahr stage, 2.1 ± 0.6; Movement Disorder Society [MDS]-revised Unified Parkinson Disease Rating Scale [UPDRS] [I-III] total score, 43.4 ± 17.8) and 30 control subjects (18 men and 12 women; mean age, 62 ± 10.3 y). 11C-DTBZ PET was performed using standard synthesis and acquisition protocols. Correlational tractography was performed to assess quantitative anisotropy (QA; a measure of tract integrity) of white matter fibers correlating with information derived from striatal 11C-DTBZ data using the DSI Studio toolbox. Scans were realigned according to least and most clinically affected cerebral hemispheres. Results: Nigrostriatal tracts were identified in both hemispheres of PD patients. Higher mean QA values along the identified tracts were significantly associated with higher striatal 11C-DTBZ distribution volume ratios (least affected: r = 0.57, P = 0.001; most affected: r = 0.44, P = 0.02). Lower mean QA values of the identified tract in the LA hemisphere associated with increased severity of bradykinesia sub-score derived from MDS-UPDRS part III (r = -0.42; P = 0.02). Cross-validation revealed the generalizability of these results. Conclusion: These findings suggest that impaired integrity of dopaminergic nigrostriatal nerve terminals is associated with nigrostriatal axonal dysfunction in mild to moderate PD. Assessment of nigrostriatal tract integrity may be suitable as a biomarker of early- or even prodromal-stage PD.
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Affiliation(s)
- Carlos A Sanchez-Catasus
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan.,Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, Michigan
| | - Nicolaas I Bohnen
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, Michigan.,Department of Neurology, University of Michigan Health System, Ann Arbor, Michigan.,Neurology Service and GRECC, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Nicholas D'Cruz
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Prabesh Kanel
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, Michigan
| | - Martijn L T M Müller
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan .,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, Michigan
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15
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Porter E, Roussakis AA, Lao-Kaim NP, Piccini P. Multimodal dopamine transporter (DAT) imaging and magnetic resonance imaging (MRI) to characterise early Parkinson's disease. Parkinsonism Relat Disord 2020; 79:26-33. [PMID: 32861103 DOI: 10.1016/j.parkreldis.2020.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 08/05/2020] [Accepted: 08/08/2020] [Indexed: 01/12/2023]
Abstract
Idiopathic Parkinson's disease (PD), the second most common neurodegenerative disorder, is characterised by the progressive loss of dopaminergic nigrostriatal terminals. Currently, in early idiopathic PD, dopamine transporter (DAT)-specific imaging assesses the extent of striatal dopaminergic deficits, and conventional magnetic resonance imaging (MRI) of the brain excludes the presence of significant ischaemic load in the basal ganglia as well as signs indicative of other forms of Parkinsonism. In this article, we discuss the use of multimodal DAT-specific and MRI protocols for insight into the early pathological features of idiopathic PD, including: structural MRI, diffusion tensor imaging, nigrosomal iron imaging and neuromelanin-sensitive MRI sequences. These measures may be acquired serially or simultaneously in a hybrid scanner. From current evidence, it appears that both nigrosomal iron imaging and neuromelanin-sensitive MRI combined with DAT-specific imaging are useful to assist clinicians in diagnosing PD, while conventional structural MRI and diffusion tensor imaging protocols are better suited to a research context focused on characterising early PD pathology. We believe that in the future multimodal imaging will be able to characterise prodromal PD and stratify the clinical stages of PD progression.
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Affiliation(s)
- Eleanor Porter
- Imperial College London, Hammersmith Hospital, Neurology Imaging Unit, London, UK
| | | | - Nicholas P Lao-Kaim
- Imperial College London, Hammersmith Hospital, Neurology Imaging Unit, London, UK
| | - Paola Piccini
- Imperial College London, Hammersmith Hospital, Neurology Imaging Unit, London, UK.
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16
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Bergamino M, Keeling EG, Mishra VR, Stokes AM, Walsh RR. Assessing White Matter Pathology in Early-Stage Parkinson Disease Using Diffusion MRI: A Systematic Review. Front Neurol 2020; 11:314. [PMID: 32477235 PMCID: PMC7240075 DOI: 10.3389/fneur.2020.00314] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/31/2020] [Indexed: 12/15/2022] Open
Abstract
Structural brain white matter (WM) changes such as axonal caliber, density, myelination, and orientation, along with WM-dependent structural connectivity, may be impacted early in Parkinson disease (PD). Diffusion magnetic resonance imaging (dMRI) has been used extensively to understand such pathological WM changes, and the focus of this systematic review is to understand both the methods utilized and their corresponding results in the context of early-stage PD. Diffusion tensor imaging (DTI) is the most commonly utilized method to probe WM pathological changes. Previous studies have suggested that DTI metrics are sensitive in capturing early disease-associated WM changes in preclinical symptomatic regions such as olfactory regions and the substantia nigra, which is considered to be a hallmark of PD pathology and progression. Postprocessing analytic approaches include region of interest-based analysis, voxel-based analysis, skeletonized approaches, and connectome analysis, each with unique advantages and challenges. While DTI has been used extensively to study WM disorganization in early-stage PD, it has several limitations, including an inability to resolve multiple fiber orientations within each voxel and sensitivity to partial volume effects. Given the subtle changes associated with early-stage PD, these limitations result in inaccuracies that severely impact the reliability of DTI-based metrics as potential biomarkers. To overcome these limitations, advanced dMRI acquisition and analysis methods have been employed, including diffusion kurtosis imaging and q-space diffeomorphic reconstruction. The combination of improved acquisition and analysis in DTI may yield novel and accurate information related to WM-associated changes in early-stage PD. In the current article, we present a systematic and critical review of dMRI studies in early-stage PD, with a focus on recent advances in DTI methodology. Yielding novel metrics, these advanced methods have been shown to detect diffuse WM changes in early-stage PD. These findings support the notion of early axonal damage in PD and suggest that WM pathology may go unrecognized until symptoms appear. Finally, the advantages and disadvantages of different dMRI techniques, analysis methods, and software employed are discussed in the context of PD-related pathology.
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Affiliation(s)
- Maurizio Bergamino
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Elizabeth G. Keeling
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ, United States
- School of Life Sciences, Arizona State University, Tempe, AZ, United States
| | - Virendra R. Mishra
- Imaging Research, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Ashley M. Stokes
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Ryan R. Walsh
- Muhammad Ali Parkinson Center, Barrow Neurological Institute, Phoenix, AZ, United States
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17
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Safai A, Prasad S, Chougule T, Saini J, Pal PK, Ingalhalikar M. Microstructural abnormalities of substantia nigra in Parkinson's disease: A neuromelanin sensitive MRI atlas based study. Hum Brain Mapp 2019; 41:1323-1333. [PMID: 31778276 PMCID: PMC7267920 DOI: 10.1002/hbm.24878] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 10/24/2019] [Accepted: 11/16/2019] [Indexed: 12/24/2022] Open
Abstract
Microstructural changes associated with degeneration of dopaminergic neurons of the substantia nigra pars compacta (SNc) in Parkinson's disease (PD) have been studied using Diffusion Tensor Imaging (DTI). However, these studies show inconsistent results, mainly due to methodological variations in delineation of SNc. To mitigate this, our work aims to construct a probabilistic atlas of SNc based on a 3D Neuromelanin Sensitive MRI (NMS‐MRI) sequence and demonstrate its applicability to investigate microstructural changes on a large dataset of PD. Using manual segmentation and deformable registration we created a novel SNc atlas in the MNI space using NMS‐MRI sequences of 27 healthy controls (HC). We first quantitatively evaluated this atlas and then employed it to investigate the micro‐structural abnormalities in SNc using diffusion MRI from 133 patients with PD and 99 HCs. Our results demonstrated significant increase in diffusivity with no changes in anisotropy. In addition, we also observed an asymmetry of the diffusion metrics with a higher diffusivity and lower anisotropy in the left SNc than the right. Finally, a multivariate classifier based on SNc diffusion features could delineate patients with PD with an average accuracy of 71.7%. Overall, from this work we establish a normative baseline for the SNc region of interest using NMS‐MRI while the application on PD data emphasizes on the contribution of diffusivity measures rather than anisotropy of white matter in PD.
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Affiliation(s)
- Apoorva Safai
- Symbiosis Center for Medical Image Analysis, Symbiosis Institute of Technology, Symbiosis International University, Pune, Maharashtra, India
| | - Shweta Prasad
- Department of Clinical Neurosciences, National Institute of Mental Health & Neurosciences, Bangalore, Karnataka, India.,Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, Karnataka, India
| | - Tanay Chougule
- Symbiosis Center for Medical Image Analysis, Symbiosis Institute of Technology, Symbiosis International University, Pune, Maharashtra, India
| | - Jitender Saini
- Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health & Neurosciences, Bangalore, Karnataka, India
| | - Pramod K Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, Karnataka, India
| | - Madhura Ingalhalikar
- Symbiosis Center for Medical Image Analysis, Symbiosis Institute of Technology, Symbiosis International University, Pune, Maharashtra, India
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18
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Pelizzari L, Laganà MM, Di Tella S, Rossetto F, Bergsland N, Nemni R, Clerici M, Baglio F. Combined Assessment of Diffusion Parameters and Cerebral Blood Flow Within Basal Ganglia in Early Parkinson's Disease. Front Aging Neurosci 2019; 11:134. [PMID: 31214017 PMCID: PMC6558180 DOI: 10.3389/fnagi.2019.00134] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/21/2019] [Indexed: 12/12/2022] Open
Abstract
Diffusion tensor imaging (DTI) is a sensitive tool for detecting brain tissue microstructural alterations in Parkinson’s disease (PD). Abnormal cerebral perfusion patterns have also been reported in PD patients using arterial spin labeling (ASL) MRI. In this study we aimed to perform a combined DTI and ASL assessment in PD patients within the basal ganglia, in order to test the relationship between microstructural and perfusion alterations. Fifty-two subjects participated in this study. Specifically, 26 PD patients [mean age (SD) = 66.7 (8.9) years, 21 males, median (IQR) Modified Hoehn and Yahr = 1.5 (1–1.6)] and twenty-six healthy controls [HC, mean age (SD) = 65.2 (7.5), 15 males] were scanned with 1.5T MRI. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD) maps were derived from diffusion-weighted images, while cerebral blood flow (CBF) maps were computed from ASL data. After registration to Montreal Neurological Institute standard space, FA, MD, AD, RD and CBF median values were extracted within specific regions of interest: substantia nigra, caudate, putamen, globus pallidus, thalamus, red nucleus and subthalamic nucleus. DTI measures and CBF were compared between the two groups. The relationship between diffusion parameters and CBF was tested with Spearman’s correlations. False discovery rate (FDR)-corrected p-values lower than 0.05 were considered significant, while uncorrected p-values <0.05 were considered a trend. No significant FA, MD and RD differences were observed. AD was significantly increased in PD patients compared with HC in the putamen (p = 0.005, pFDR = 0.035). No significant CBF differences were found between PD patients and HC. Diffusion parameters were not significantly correlated with CBF in the HC group, while a significant correlation emerged for PD patients in the caudate nucleus, for all DTI measures (with FA: r = 0.543, pFDR = 0.028; with MD: r = −0.661, pFDR = 0.002; with AD: r = −0.628, pFDR = 0.007; with RD: r = −0.635, pFDR = 0.003). This study showed that DTI is a more sensitive technique than ASL to detect alterations in the basal ganglia in the early phase of PD. Our results suggest that, although DTI and ASL convey different information, a relationship between microstructural integrity and perfusion changes in the caudate may be present.
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Affiliation(s)
| | | | | | | | - Niels Bergsland
- IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy.,Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Raffaello Nemni
- IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Mario Clerici
- IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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19
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Hope TR, Selnes P, Rektorová I, Anderkova L, Nemcova-Elfmarkova N, Balážová Z, Dale A, Bjørnerud A, Fladby T. Diffusion tensor and restriction spectrum imaging reflect different aspects of neurodegeneration in Parkinson's disease. PLoS One 2019; 14:e0217922. [PMID: 31150514 PMCID: PMC6544302 DOI: 10.1371/journal.pone.0217922] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/21/2019] [Indexed: 11/19/2022] Open
Abstract
To meet the need for Parkinson's disease biomarkers and evidence for amount and distribution of pathological changes, MRI diffusion tensor imaging (DTI) has been explored in a number of previous studies. However, conflicting results warrant further investigations. As tissue microstructure, particularly of the grey matter, is heterogeneous, a more precise diffusion model may benefit tissue characterization. The purpose of this study was to analyze the diffusion-based imaging technique restriction spectrum imaging (RSI) and DTI, and their ability to detect microstructural changes within brain regions associated with motor function in Parkinson's disease. Diffusion weighted (DW) MR images of a total of 100 individuals, (46 Parkinson's disease patients and 54 healthy controls) were collected using b-values of 0-4000s/mm2. Output diffusion-based maps were estimated based on the RSI-model combining the full set of DW-images (Cellular Index (CI), Neurite Density (ND)) and DTI-model combining b = 0 and b = 1000 s/mm2 (fractional anisotropy (FA), Axial-, Mean- and Radial diffusivity (AD, MD, RD)). All parametric maps were analyzed in a voxel-wise group analysis, with focus on typical brain regions associated with Parkinson's disease pathology. CI, ND and DTI diffusivity metrics (AD, MD, RD) demonstrated the ability to differentiate between groups, with strongest performance within the thalamus, prone to pathology in Parkinson's disease. Our results indicate that RSI may improve the predictive power of diffusion-based MRI, and provide additional information when combined with the standard diffusivity measurements. In the absence of major atrophy, diffusion techniques may reveal microstructural pathology. Our results suggest that protocols for MRI diffusion imaging may be adapted to more sensitive detection of pathology at different sites of the central nervous system.
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Affiliation(s)
- Tuva R. Hope
- Diagnostic Physics, Division of Radiology & Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- * E-mail:
| | - Per Selnes
- Department of Neurology, Akershus University Hospital, Loerenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Irena Rektorová
- Central European Institute of Technology, CEITEC Masaryk University, Brno, Czech Republic
- First Department of Neurology, Medical Faculty, Masaryk University and St. Anne’s University Hospital, Brno, Czech Republic
| | - Lubomira Anderkova
- Central European Institute of Technology, CEITEC Masaryk University, Brno, Czech Republic
| | | | - Zuzana Balážová
- Central European Institute of Technology, CEITEC Masaryk University, Brno, Czech Republic
| | - Anders Dale
- Department of Neurosciences, University of California, San Diego, La Jolla, California, United States of America
- Deparment of Radiology, University of California San Diego, San Diego, La Jolla, California, United States of America
- Deparment of Cognitive Sciences, University of California San Diego, San Diego, La Jolla, California, United States of America
| | - Atle Bjørnerud
- Diagnostic Physics, Division of Radiology & Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | - Tormod Fladby
- Department of Neurology, Akershus University Hospital, Loerenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
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20
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Zhong Z, Merkitch D, Karaman MM, Zhang J, Sui Y, Goldman JG, Zhou XJ. High-Spatial-Resolution Diffusion MRI in Parkinson Disease: Lateral Asymmetry of the Substantia Nigra. Radiology 2019; 291:149-157. [PMID: 30777809 DOI: 10.1148/radiol.2019181042] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Motor symptoms in Parkinson disease (PD) have exhibited lateral asymmetry, suggesting asymmetric neuronal loss in the substantia nigra (SN). Diffusion MRI may be able to help confirm tissue microstructural alterations in the substantia nigra to probe for the presence of asymmetry. Purpose To investigate lateral asymmetry in the SN of patients with PD by using diffusion MRI with both Gaussian and non-Gaussian models. Materials and Methods In this cross-sectional study conducted from March 2015 to March 2017, 27 participants with PD and 27 age-matched healthy control (HC) participants, all right handed, underwent MRI at 3.0 T. High-spatial-resolution diffusion images were acquired with a reduced field of view by using seven b values up to 3000 sec/mm2. A continuous-time random-walk (CTRW) non-Gaussian diffusion model was used to produce anomalous diffusion coefficient (Dm) and temporal (α) and spatial (β) diffusion heterogeneity indexes followed by a Gaussian diffusion model to yield an apparent diffusion coefficient (ADC). Individual or linear combinations of diffusion parameters in the SN were unilaterally and bilaterally compared between the PD and HC groups. Results In the bilateral comparison between the PD and HC groups, differences were observed in β (0.67 ± 0.06 [standard deviation] vs 0.64 ± 0.04, respectively; P = .016), ADC (0.48 μm2/msec ± 0.08 vs 0.53 μm2/msec ± 0.06, respectively; P = .03), and the combination of CTRW parameters (P = .02). In the unilateral comparison, differences were observed in all diffusion parameters on the left SN (P < .03), but not on the right (P > .20). In a receiver operating characteristic (ROC) analysis to delineate left SN abnormality in PD, the combination of Dm, α, and β produced the best sensitivity (sensitivity, 0.78); the combination of Dm and β produced the best specificity (specificity, 0.85); and the combination of α and β produced the largest area under the ROC curve (area under the ROC curve, 0.73). Conclusion These results suggest that quantitative diffusion MRI is sensitive to brain tissue changes in participants with Parkinson disease and provide evidence of substantia nigra lateral asymmetry in this disease. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Zheng Zhong
- From the Center for Magnetic Resonance Research (Z.Z., M.M.K., J.Z., Y.S., X.J.Z.), Departments of Radiology (X.J.Z.), Neurosurgery (X.J.Z.), and Bioengineering (Z.Z., M.M.K., X.J.Z.), University of Illinois at Chicago, 2242 W Harrison St, Suite 103, Chicago, IL 60612; Department of Neurological Sciences, Rush University Medical Center, Professional Building, Chicago, Ill (D.M., J.G.G.); and Department of Radiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China (J.Z.)
| | - Douglas Merkitch
- From the Center for Magnetic Resonance Research (Z.Z., M.M.K., J.Z., Y.S., X.J.Z.), Departments of Radiology (X.J.Z.), Neurosurgery (X.J.Z.), and Bioengineering (Z.Z., M.M.K., X.J.Z.), University of Illinois at Chicago, 2242 W Harrison St, Suite 103, Chicago, IL 60612; Department of Neurological Sciences, Rush University Medical Center, Professional Building, Chicago, Ill (D.M., J.G.G.); and Department of Radiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China (J.Z.)
| | - M Muge Karaman
- From the Center for Magnetic Resonance Research (Z.Z., M.M.K., J.Z., Y.S., X.J.Z.), Departments of Radiology (X.J.Z.), Neurosurgery (X.J.Z.), and Bioengineering (Z.Z., M.M.K., X.J.Z.), University of Illinois at Chicago, 2242 W Harrison St, Suite 103, Chicago, IL 60612; Department of Neurological Sciences, Rush University Medical Center, Professional Building, Chicago, Ill (D.M., J.G.G.); and Department of Radiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China (J.Z.)
| | - Jiaxuan Zhang
- From the Center for Magnetic Resonance Research (Z.Z., M.M.K., J.Z., Y.S., X.J.Z.), Departments of Radiology (X.J.Z.), Neurosurgery (X.J.Z.), and Bioengineering (Z.Z., M.M.K., X.J.Z.), University of Illinois at Chicago, 2242 W Harrison St, Suite 103, Chicago, IL 60612; Department of Neurological Sciences, Rush University Medical Center, Professional Building, Chicago, Ill (D.M., J.G.G.); and Department of Radiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China (J.Z.)
| | - Yi Sui
- From the Center for Magnetic Resonance Research (Z.Z., M.M.K., J.Z., Y.S., X.J.Z.), Departments of Radiology (X.J.Z.), Neurosurgery (X.J.Z.), and Bioengineering (Z.Z., M.M.K., X.J.Z.), University of Illinois at Chicago, 2242 W Harrison St, Suite 103, Chicago, IL 60612; Department of Neurological Sciences, Rush University Medical Center, Professional Building, Chicago, Ill (D.M., J.G.G.); and Department of Radiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China (J.Z.)
| | - Jennifer G Goldman
- From the Center for Magnetic Resonance Research (Z.Z., M.M.K., J.Z., Y.S., X.J.Z.), Departments of Radiology (X.J.Z.), Neurosurgery (X.J.Z.), and Bioengineering (Z.Z., M.M.K., X.J.Z.), University of Illinois at Chicago, 2242 W Harrison St, Suite 103, Chicago, IL 60612; Department of Neurological Sciences, Rush University Medical Center, Professional Building, Chicago, Ill (D.M., J.G.G.); and Department of Radiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China (J.Z.)
| | - Xiaohong Joe Zhou
- From the Center for Magnetic Resonance Research (Z.Z., M.M.K., J.Z., Y.S., X.J.Z.), Departments of Radiology (X.J.Z.), Neurosurgery (X.J.Z.), and Bioengineering (Z.Z., M.M.K., X.J.Z.), University of Illinois at Chicago, 2242 W Harrison St, Suite 103, Chicago, IL 60612; Department of Neurological Sciences, Rush University Medical Center, Professional Building, Chicago, Ill (D.M., J.G.G.); and Department of Radiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China (J.Z.)
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Yang J, Archer DB, Burciu RG, Müller MLTM, Roy A, Ofori E, Bohnen NI, Albin RL, Vaillancourt DE. Multimodal dopaminergic and free-water imaging in Parkinson's disease. Parkinsonism Relat Disord 2019; 62:10-15. [PMID: 30639168 DOI: 10.1016/j.parkreldis.2019.01.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/17/2018] [Accepted: 01/04/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION When using free-water diffusion imaging or positron emission tomography (PET), it is established that substania nigra microstructure and presynaptic dopamine activity are impaired in early PD. It is not well understood if these two forms of degeneration are redundant, or if they each provide a unique contribution to the clinical motor and cognitive symptoms. METHODS A total of 129 PD and 75 control individuals underwent motor and cognitive evaluations, and in vivo [11C]dihydrotetrabenazine (DTBZ) monoaminergic brain PET imaging and diffusion imaging. Correlations between free-water in the substantia nigra and striatal PET measures were analyzed. Unbiased multiple regression using a backward elimination method was performed between clinical severity and all imaging measures. RESULTS Inverse correlations were found between free-water in posterior substantia nigra and DTBZ binding in putamen and caudate. Multiple regression revealed that increased free-water in the posterior substantia nigra, decreased DTBZ binding in putamen, and age were predictors of higher Hoehn and Yahr stage, MDS-UPDRS III scores, and posture and gait sub-scores. Increased posterior substantia nigra free-water alone was associated tremor scores. Free-water in caudate and putamen did not predict measures of motor performance. Decreased DTBZ binding in caudate, increased free-water in caudate and posterior substantia nigra were associated with higher dementia ratings. CONCLUSIONS These findings suggest that free-water in the posterior substantia nigra and presynaptic dopamine imaging in striatum are uniquely associated with the clinical symptoms of PD, indicating that each imaging modality may be measuring a unique mechanism relevant to nigrostriatal degeneration.
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Affiliation(s)
- Jing Yang
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL,USA; Department of Neurology, West China Hospital of Sichuan University, Chengdu, China.
| | - Derek B Archer
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL,USA.
| | - Roxana G Burciu
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
| | - Martijn L T M Müller
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; University of Michigan, Morris K Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, USA.
| | - Arnab Roy
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL,USA.
| | - Edward Ofori
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
| | - Nicolaas I Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; University of Michigan, Morris K Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, USA; Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, USA.
| | - Roger L Albin
- University of Michigan, Morris K Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, USA; Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, USA.
| | - David E Vaillancourt
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL,USA; Department of Neurology, University of Florida, Gainesville, FL,USA; Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.
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22
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Marek K, Chowdhury S, Siderowf A, Lasch S, Coffey CS, Caspell‐Garcia C, Simuni T, Jennings D, Tanner CM, Trojanowski JQ, Shaw LM, Seibyl J, Schuff N, Singleton A, Kieburtz K, Toga AW, Mollenhauer B, Galasko D, Chahine LM, Weintraub D, Foroud T, Tosun‐Turgut D, Poston K, Arnedo V, Frasier M, Sherer T. The Parkinson's progression markers initiative (PPMI) - establishing a PD biomarker cohort. Ann Clin Transl Neurol 2018; 5:1460-1477. [PMID: 30564614 PMCID: PMC6292383 DOI: 10.1002/acn3.644] [Citation(s) in RCA: 274] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The Parkinson's Progression Markers Initiative (PPMI) is an observational, international study designed to establish biomarker-defined cohorts and identify clinical, imaging, genetic, and biospecimen Parkinson's disease (PD) progression markers to accelerate disease-modifying therapeutic trials. METHODS A total of 423 untreated PD, 196 Healthy Control (HC) and 64 SWEDD (scans without evidence of dopaminergic deficit) subjects were enrolled at 24 sites. To enroll PD subjects as early as possible following diagnosis, subjects were eligible with only asymmetric bradykinesia or tremor plus a dopamine transporter (DAT) binding deficit on SPECT imaging. Acquisition of data was standardized as detailed at www.ppmi-info.org. RESULTS Approximately 9% of enrolled subjects had a single PD sign at baseline. DAT imaging excluded 16% of potential PD subjects with SWEDD. The total MDS-UPDRS for PD was 32.4 compared to 4.6 for HC and 28.2 for SWEDD. On average, PD subjects demonstrated 45% and 68% reduction in mean striatal and contralateral putamen Specific Binding Ratios (SBR), respectively. Cerebrospinal fluid (CSF) was acquired from >97% of all subjects. CSF (PD/HC/SWEDD pg/mL) α-synuclein (1845/2204/2141) was reduced in PD vs HC or SWEDD (P < 0.03). Similarly, t-tau (45/53) and p-tau (16/18) were reduced in PD versus HC (P < 0.01). INTERPRETATION PPMI has detailed the biomarker signature for an early PD cohort defined by clinical features and imaging biomarkers. This strategy provides the framework to establish biomarker cohorts and to define longitudinal progression biomarkers to support future PD treatment trials.
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Affiliation(s)
- Kenneth Marek
- Institute for Neurodegenerative DisordersNew HavenConnecticut
| | - Sohini Chowdhury
- The Michael J. Fox Foundation for Parkinson's ResearchNew YorkNew York
| | | | - Shirley Lasch
- Institute for Neurodegenerative DisordersNew HavenConnecticut
| | | | | | | | | | | | | | | | - John Seibyl
- Institute for Neurodegenerative DisordersNew HavenConnecticut
| | | | | | - Karl Kieburtz
- Clinical Trials Coordination CenterUniversity of RochesterRochesterNew York
| | | | | | | | | | | | | | | | | | - Vanessa Arnedo
- The Michael J. Fox Foundation for Parkinson's ResearchNew YorkNew York
| | - Mark Frasier
- The Michael J. Fox Foundation for Parkinson's ResearchNew YorkNew York
| | - Todd Sherer
- The Michael J. Fox Foundation for Parkinson's ResearchNew YorkNew York
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23
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Bledsoe IO, Stebbins GT, Merkitch D, Goldman JG. White matter abnormalities in the corpus callosum with cognitive impairment in Parkinson disease. Neurology 2018; 91:e2244-e2255. [PMID: 30429273 DOI: 10.1212/wnl.0000000000006646] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 08/23/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate microstructural characteristics of the corpus callosum using diffusion tensor imaging (DTI) and their relationships to cognitive impairment in Parkinson disease (PD). METHODS Seventy-five participants with PD and 24 healthy control (HC) participants underwent structural MRI brain scans including DTI sequences and clinical and neuropsychological evaluations. Using Movement Disorder Society criteria, PD participants were classified as having normal cognition (PD-NC, n = 23), mild cognitive impairment (PD-MCI, n = 35), or dementia (PDD, n = 17). Cognitive domain (attention/working memory, executive function, language, memory, visuospatial function) z scores were calculated. DTI scalar values, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD), were established for 5 callosal segments on a midsagittal plane, single slice using a topographically derived parcellation method. Scalar values were compared among participant groups. Regression analyses were performed on cognitive domain z scores and DTI metrics. RESULTS Participants with PD showed increased AD values in the anterior 3 callosal segments compared to healthy controls. Participants with PDD had significantly increased AD, MD, and RD in the anterior 2 segments compared to participants with PD-NC and most anterior segment compared to participants with PD-MCI. FA values did not differ significantly between participants with PD and participants with HC or among PD cognitive groups. The strongest associations for the DTI metrics and cognitive performance occurred in the most anterior and most posterior callosal segments, and also reflected fronto-striatal and posterior cortical type cognitive deficits, respectively. CONCLUSIONS Microstructural white matter abnormalities of the corpus callosum, as measured by DTI, may contribute to PD cognitive impairment by disrupting information transfer across interhemispheric and callosal-cortical projections.
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Affiliation(s)
- Ian O Bledsoe
- From the Movement Disorder and Neuromodulation Center (I.O.B.), Department of Neurology, University of California, San Francisco; and the Section of Parkinson Disease and Movement Disorders (G.T.S., D.M., J.G.G.), Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Glenn T Stebbins
- From the Movement Disorder and Neuromodulation Center (I.O.B.), Department of Neurology, University of California, San Francisco; and the Section of Parkinson Disease and Movement Disorders (G.T.S., D.M., J.G.G.), Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Doug Merkitch
- From the Movement Disorder and Neuromodulation Center (I.O.B.), Department of Neurology, University of California, San Francisco; and the Section of Parkinson Disease and Movement Disorders (G.T.S., D.M., J.G.G.), Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Jennifer G Goldman
- From the Movement Disorder and Neuromodulation Center (I.O.B.), Department of Neurology, University of California, San Francisco; and the Section of Parkinson Disease and Movement Disorders (G.T.S., D.M., J.G.G.), Department of Neurological Sciences, Rush University Medical Center, Chicago, IL.
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24
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MEETING REPORTER. Curr Opin Neurol 2018; 30 Suppl 1:1-24. [DOI: 10.1097/wco.0000000000000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Guttuso T, Bergsland N, Hagemeier J, Lichter DG, Pasternak O, Zivadinov R. Substantia Nigra Free Water Increases Longitudinally in Parkinson Disease. AJNR Am J Neuroradiol 2018; 39:479-484. [PMID: 29419398 DOI: 10.3174/ajnr.a5545] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/19/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Free water in the posterior substantia nigra obtained from a bi-tensor diffusion MR imaging model has been shown to significantly increase over 1- and 4-year periods in patients with early-stage idiopathic Parkinson disease compared with healthy controls, which suggests that posterior substantia nigra free water may be an idiopathic Parkinson disease progression biomarker. Due to the known temporal posterior-to-anterior substantia nigra degeneration in idiopathic Parkinson disease, we assessed longitudinal changes in free water in both the posterior and anterior substantia nigra in patients with later-stage idiopathic Parkinson disease and age-matched healthy controls for comparison. MATERIALS AND METHODS Nineteen subjects with idiopathic Parkinson disease and 19 age-matched healthy control subjects were assessed on the same 3T MR imaging scanner at baseline and after approximately 3 years. RESULTS Baseline mean idiopathic Parkinson disease duration was 7.1 years. Both anterior and posterior substantia nigra free water showed significant intergroup differences at baseline (P < .001 and P = .014, respectively, idiopathic Parkinson disease versus healthy controls); however, only anterior substantia nigra free water showed significant longitudinal group × time interaction increases (P = .021, idiopathic Parkinson disease versus healthy controls). There were no significant longitudinal group × time interaction differences found for conventional diffusion tensor imaging or free water-corrected DTI assessments in either the anterior or posterior substantia nigra. CONCLUSIONS Results from this study provide further evidence supporting substantia nigra free water as a promising disease-progression biomarker in idiopathic Parkinson disease that may help to identify disease-modifying therapies if used in future clinical trials. Our novel finding of longitudinal increases in anterior but not posterior substantia nigra free water is potentially a result of the much longer disease duration of our cohort compared with previously studied cohorts and the known posterior-to-anterior substantia nigra degeneration that occurs over time in idiopathic Parkinson disease.
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Affiliation(s)
- T Guttuso
- From the Movement Disorder Center (T.G., D.G.L.)
| | - N Bergsland
- Buffalo Neuroimaging Analysis Center (N.B., J.H., R.Z.), Department of Neurology
| | - J Hagemeier
- Buffalo Neuroimaging Analysis Center (N.B., J.H., R.Z.), Department of Neurology
| | - D G Lichter
- From the Movement Disorder Center (T.G., D.G.L.)
| | - O Pasternak
- Departments of Psychiatry and Radiology (O.P.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - R Zivadinov
- Buffalo Neuroimaging Analysis Center (N.B., J.H., R.Z.), Department of Neurology.,MR Imaging Clinical and Translational Research Center (R.Z.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
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26
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Météreau E, Beaudoin-Gobert M, Duperrier S, Thobois S, Tremblay L, Sgambato-Faure V. Diffusion tensor imaging marks dopaminergic and serotonergic lesions in the Parkinsonian monkey. Mov Disord 2017; 33:298-309. [DOI: 10.1002/mds.27201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/24/2017] [Accepted: 08/27/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Elise Météreau
- Université de Lyon, Centre National de la Recherche Scientifique, Institut des Sciences Cognitives Marc Jeannerod; Bron France
| | - Maude Beaudoin-Gobert
- Université de Lyon, Centre National de la Recherche Scientifique, Institut des Sciences Cognitives Marc Jeannerod; Bron France
| | - Sandra Duperrier
- Université de Lyon, Centre National de la Recherche Scientifique, Institut des Sciences Cognitives Marc Jeannerod; Bron France
| | - Stéphane Thobois
- Université de Lyon, Centre National de la Recherche Scientifique, Institut des Sciences Cognitives Marc Jeannerod; Bron France
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer; Lyon France
| | - Léon Tremblay
- Université de Lyon, Centre National de la Recherche Scientifique, Institut des Sciences Cognitives Marc Jeannerod; Bron France
| | - Véronique Sgambato-Faure
- Université de Lyon, Centre National de la Recherche Scientifique, Institut des Sciences Cognitives Marc Jeannerod; Bron France
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27
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Heim B, Krismer F, De Marzi R, Seppi K. Magnetic resonance imaging for the diagnosis of Parkinson's disease. J Neural Transm (Vienna) 2017; 124:915-964. [PMID: 28378231 PMCID: PMC5514207 DOI: 10.1007/s00702-017-1717-8] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/22/2017] [Indexed: 12/11/2022]
Abstract
The differential diagnosis of parkinsonian syndromes is considered one of the most challenging in neurology and error rates in the clinical diagnosis can be high even at specialized centres. Despite several limitations, magnetic resonance imaging (MRI) has undoubtedly enhanced the diagnostic accuracy in the differential diagnosis of neurodegenerative parkinsonism over the last three decades. This review aims to summarize research findings regarding the value of the different MRI techniques, including advanced sequences at high- and ultra-high-field MRI and modern image analysis algorithms, in the diagnostic work-up of Parkinson's disease. This includes not only the exclusion of alternative diagnoses for Parkinson's disease such as symptomatic parkinsonism and atypical parkinsonism, but also the diagnosis of early, new onset, and even prodromal Parkinson's disease.
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Affiliation(s)
- Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Roberto De Marzi
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria.
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28
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Ofori E, Krismer F, Burciu RG, Pasternak O, McCracken JL, Lewis MM, Du G, McFarland NR, Okun MS, Poewe W, Mueller C, Gizewski ER, Schocke M, Kremser C, Li H, Huang X, Seppi K, Vaillancourt DE. Free water improves detection of changes in the substantia nigra in parkinsonism: A multisite study. Mov Disord 2017; 32:1457-1464. [PMID: 28714593 DOI: 10.1002/mds.27100] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 05/19/2017] [Accepted: 06/11/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Imaging markers that are sensitive to parkinsonism across multiple sites are critically needed for clinical trials. The objective of this study was to evaluate changes in the substantia nigra using single- and bi-tensor models of diffusion magnetic resonance imaging in PD, MSA, and PSP. METHODS The study cohort (n = 425) included 107 healthy controls and 184 PD, 63 MSA, and 71 PSP patients from 3 movement disorder centers. Bi-tensor free water, free-water-corrected fractional anisotropy, free-water-corrected mean diffusivity, single-tensor fractional anisotropy, and single-tensor mean diffusivity were computed for the anterior and posterior substantia nigra. Correlations were computed between diffusion MRI measures and clinical measures. RESULTS In the posterior substantia nigra, free water was greater for PSP than MSA and PD patients and controls. PD and MSA both had greater free water than controls. Free-water-corrected fractional anisotropy values were greater for PSP patents than for controls and PD patients. PSP and MSA patient single-tensor mean diffusivity values were greater than controls, and single-tensor fractional anisotropy values were lower for PSP patients than for healthy controls. The parkinsonism effect size for free water was 0.145 in the posterior substantia nigra and 0.072 for single-tensor mean diffusivity. The direction of correlations between single-tensor mean diffusivity and free-water values and clinical scores was similar at each site. CONCLUSIONS Free-water values in the posterior substantia nigra provide a consistent pattern of findings across patients with PD, MSA, and PSP in a large cohort across 3 sites. Free water in the posterior substantia nigra relates to clinical measures of motor and cognitive symptoms in a large cohort of parkinsonism. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Edward Ofori
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Florian Krismer
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Roxana G Burciu
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Ofer Pasternak
- Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Johanna L McCracken
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Mechelle M Lewis
- Department of Neurology, Penn State - Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.,Department of Pharmacology, Penn State - Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Guangwei Du
- Department of Neurology, Penn State - Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Nikolaus R McFarland
- Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida, USA.,Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Michael S Okun
- Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida, USA.,Department of Neurology, University of Florida, Gainesville, Florida, USA.,Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Werner Poewe
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria
| | - Christoph Mueller
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Elke R Gizewski
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria.,Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Schocke
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria.,Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Kremser
- Neuroimaging Research Core Facility, Medical University Innsbruck, Innsbruck, Austria.,Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Hong Li
- Department of Public Health Sciences, Medical College of South Carolina, Charleston, South Carolina, USA
| | - Xuemei Huang
- Department of Neurology, Penn State - Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.,Department of Pharmacology, Penn State - Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.,Departments of Neurosurgery, Radiology, and Kinesiology, Penn State - Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Klaus Seppi
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - David E Vaillancourt
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA.,Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida, USA.,Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
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Caspell-Garcia C, Simuni T, Tosun-Turgut D, Wu IW, Zhang Y, Nalls M, Singleton A, Shaw LA, Kang JH, Trojanowski JQ, Siderowf A, Coffey C, Lasch S, Aarsland D, Burn D, Chahine LM, Espay AJ, Foster ED, Hawkins KA, Litvan I, Richard I, Weintraub D. Multiple modality biomarker prediction of cognitive impairment in prospectively followed de novo Parkinson disease. PLoS One 2017; 12:e0175674. [PMID: 28520803 PMCID: PMC5435130 DOI: 10.1371/journal.pone.0175674] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/29/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To assess the neurobiological substrate of initial cognitive decline in Parkinson's disease (PD) to inform patient management, clinical trial design, and development of treatments. METHODS We longitudinally assessed, up to 3 years, 423 newly diagnosed patients with idiopathic PD, untreated at baseline, from 33 international movement disorder centers. Study outcomes were four determinations of cognitive impairment or decline, and biomarker predictors were baseline dopamine transporter (DAT) single photon emission computed tomography (SPECT) scan, structural magnetic resonance imaging (MRI; volume and thickness), diffusion tensor imaging (mean diffusivity and fractional anisotropy), cerebrospinal fluid (CSF; amyloid beta [Aβ], tau and alpha synuclein), and 11 single nucleotide polymorphisms (SNPs) previously associated with PD cognition. Additionally, longitudinal structural MRI and DAT scan data were included. Univariate analyses were run initially, with false discovery rate = 0.2, to select biomarker variables for inclusion in multivariable longitudinal mixed-effect models. RESULTS By year 3, cognitive impairment was diagnosed in 15-38% participants depending on the criteria applied. Biomarkers, some longitudinal, predicting cognitive impairment in multivariable models were: (1) dopamine deficiency (decreased caudate and putamen DAT availability); (2) diffuse, cortical decreased brain volume or thickness (frontal, temporal, parietal, and occipital lobe regions); (3) co-morbid Alzheimer's disease Aβ amyloid pathology (lower CSF Aβ 1-42); and (4) genes (COMT val/val and BDNF val/val genotypes). CONCLUSIONS Cognitive impairment in PD increases in frequency 50-200% in the first several years of disease, and is independently predicted by biomarker changes related to nigrostriatal or cortical dopaminergic deficits, global atrophy due to possible widespread effects of neurodegenerative disease, co-morbid Alzheimer's disease plaque pathology, and genetic factors.
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Affiliation(s)
- Chelsea Caspell-Garcia
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, United States of America
| | - Tanya Simuni
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Duygu Tosun-Turgut
- University of California, San Francisco, San Francisco, CA, United States of America
| | - I-Wei Wu
- University of California, San Francisco, San Francisco, CA, United States of America
| | - Yu Zhang
- University of California, San Francisco, San Francisco, CA, United States of America
| | - Mike Nalls
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, United States of America
| | - Andrew Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, United States of America
| | - Leslie A. Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Ju-Hee Kang
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Pharmacology & Clinical Pharmacology, Inha University School of Medicine, Incheon, Republic of Korea
| | - John Q. Trojanowski
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Andrew Siderowf
- Avid Radiopharmaceuticals, Philadelphia, PA, United States of America
| | - Christopher Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, United States of America
| | - Shirley Lasch
- Institute for Neurodegenerative Disorders (IND) and Molecular NeuroImaging, LLC (MNI), New Haven CT, United States of America
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, England
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - David Burn
- Institute for Ageing and Health, Newcastle University, Newcastle, England
| | - Lana M. Chahine
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Alberto J. Espay
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, United States of America
| | - Eric D. Foster
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, United States of America
| | - Keith A. Hawkins
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Irene Litvan
- UCSD Movement Disorder Center, Department of Neurosciences, University of California San Diego, San Diego, CA, United States of America
| | - Irene Richard
- Departments of Neurology and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | - Daniel Weintraub
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
- Parkinson’s Disease Research, Education and Clinical Center (PADRECC and MIRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, United States of America
- Mental Illness Research, Education and Clinical Center (MIRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, United States of America
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Grigoletto J, Pukaß K, Gamliel A, Davidi D, Katz-Brull R, Richter-Landsberg C, Sharon R. Higher levels of myelin phospholipids in brains of neuronal α-Synuclein transgenic mice precede myelin loss. Acta Neuropathol Commun 2017; 5:37. [PMID: 28482862 PMCID: PMC5421332 DOI: 10.1186/s40478-017-0439-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/26/2017] [Indexed: 01/22/2023] Open
Abstract
α-Synuclein is a protein involved in the pathogenesis of synucleinopathies, including Parkinson’s disease (PD), dementia with Lewy bodies (DLB) and multiple system atrophy (MSA). We investigated the role of neuronal α-Syn in myelin composition and abnormalities. The phospholipid content of purified myelin was determined by 31P NMR in two mouse lines modeling PD, PrP-A53T α-Syn and Thy-1 wt-α-Syn. Significantly higher levels of phospholipids were detected in myelin purified from brains of these α-Syn transgenic mouse models than in control mice. Nevertheless, myelin ultrastructure appeared intact. To further investigate the effect of α-Syn on myelin abnormalities, we systematically analyzed the striatum, a brain region associated with neurodegeneration in PD. An age and disease-dependent loss of myelin basic protein (MBP) signal was detected by immunohistochemistry in striatal striosomes (patches). The age-dependent loss of MBP signal was associated with lower P25α levels in oligodendrocytes. In addition, we found that α-Syn inhibited oligodendrocyte maturation and the formation of membranous sheets in vitro. Based on these results we concluded that neuronal α-Syn is involved in the regulation and/or maintenance of myelin phospholipid. However, axonal hypomyelination in the PD models is evident only in progressive stages of the disease and associated with α-Syn toxicity.
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Early and progressive microstructural brain changes in mice overexpressing human α-Synuclein detected by diffusion kurtosis imaging. Brain Behav Immun 2017; 61:197-208. [PMID: 27923670 DOI: 10.1016/j.bbi.2016.11.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/18/2016] [Accepted: 11/27/2016] [Indexed: 12/27/2022] Open
Abstract
Diffusion kurtosis imaging (DKI) is sensitive in detecting α-Synuclein (α-Syn) accumulation-associated microstructural changes at late stages of the pathology in α-Syn overexpressing TNWT-61 mice. The aim of this study was to perform DKI in young TNWT-61 mice when α-Syn starts to accumulate and to compare the imaging results with an analysis of motor and memory impairment and α-Syn levels. Three-month-old (3mo) and six-month-old (6mo) mice underwent DKI scanning using the Bruker Avance 9.4T magnetic resonance imaging system. Region of interest (ROI) analyses were performed in the gray matter; tract-based spatial statistics (TBSS) analyses were performed in the white matter. In the same mice, α-Syn expression was evaluated using quantitative immunofluorescence. Mean kurtosis (MK) was the best differentiator between TNWT-61 mice and wildtype (WT) mice. We found increases in MK in 3mo TNWT-61 mice in the striatum and thalamus but not in the substantia nigra (SN), hippocampus, or sensorimotor cortex, even though the immunoreactivity of human α-Syn was similar or even higher in the latter regions. Increases in MK in the SN were detected in 6mo mice. These findings indicate that α-Syn accumulation-associated changes may start in areas with a high density of dopaminergic nerve terminals. We also found TBSS changes in white matter only at 6mo, suggesting α-Syn accumulation-associated changes start in the gray matter and later progress to the white matter. MK is able to detect microstructural changes induced by α-Syn overexpression in TNWT-61 mice and could be a useful clinical tool for detecting early-stage Parkinson's disease in human patients.
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Lenfeldt N, Eriksson J, Åström B, Forsgren L, Mo SJ. Fractional Anisotropy and Mean Diffusion as Measures of Dopaminergic Function in Parkinson’s Disease: Challenging Results. JOURNAL OF PARKINSONS DISEASE 2017; 7:129-142. [DOI: 10.3233/jpd-161011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Niklas Lenfeldt
- Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Johan Eriksson
- Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Björn Åström
- Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Lars Forsgren
- Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
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Son SJ, Kim M, Park H. Imaging analysis of Parkinson's disease patients using SPECT and tractography. Sci Rep 2016; 6:38070. [PMID: 27901100 PMCID: PMC5128922 DOI: 10.1038/srep38070] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 11/04/2016] [Indexed: 12/13/2022] Open
Abstract
Parkinson's disease (PD) is a degenerative disorder that affects the central nervous system. PD-related alterations in structural and functional neuroimaging have not been fully explored. This study explored multi-modal PD neuroimaging and its application for predicting clinical scores on the Movement Disorder Society-sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Multi-modal imaging that combined 123I-Ioflupane single-photon emission computed tomography (SPECT) and diffusion tensor imaging (DTI) were adopted to incorporate complementary brain imaging information. SPECT and DTI images of normal controls (NC; n = 45) and PD patients (n = 45) were obtained from a database. The specific binding ratio (SBR) was calculated from SPECT. Tractography was performed using DTI. Group-wise differences between NC and PD patients were quantified using SBR of SPECT and structural connectivity of DTI for regions of interest (ROIs) related to PD. MDS-UPDRS scores were predicted using multi-modal imaging features in a partial least-squares regression framework. Three regions and four connections within the cortico-basal ganglia thalamocortical circuit were identified using SBR and DTI, respectively. Predicted MDS-UPDRS scores using identified regions and connections and actual MDS-UPDRS scores showed a meaningful correlation (r = 0.6854, p < 0.001). Our study provided insight on regions and connections that are instrumental in PD.
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Affiliation(s)
- Seong-Jin Son
- Department of Electronic, Electrical, and Computer Engineering, Sungkyunkwan University, Suwon, Korea
| | - Mansu Kim
- Department of Electronic, Electrical, and Computer Engineering, Sungkyunkwan University, Suwon, Korea
| | - Hyunjin Park
- School of Electronic and Electrical Engineering, Sungkyunkwan University, Korea
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science, Korea
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Progression of Regional Microstructural Degeneration in Parkinson's Disease: A Multicenter Diffusion Tensor Imaging Study. PLoS One 2016; 11:e0165540. [PMID: 27798653 PMCID: PMC5087900 DOI: 10.1371/journal.pone.0165540] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/13/2016] [Indexed: 01/11/2023] Open
Abstract
This study aimed to identify the utility of diffusion tensor imaging (DTI) in measuring the regional distribution of abnormal microstructural progression in patients with Parkinson’s disease who were enrolled in the Parkinson's progression marker initiative (PPMI). One hundred and twenty two de-novo PD patients (age = 60.5±9) and 50 healthy controls (age = 60.6±11) had DTI scans at baseline and 12.6±1 months later. Automated image processing included an intra-subject registration of all time points and an inter-subjects registration to a brain atlas. Annualized rates of DTI variations including fractional anisotropy (FA), radial (rD) and axial (aD) diffusivity were estimated in a total of 118 white matter and subcortical regions of interest. A mixed effects model framework was used to determine the degree to which DTI changes differed in PD relative to changes in healthy subjects. Significant DTI changes were also tested for correlations with changes in clinical measures, dopaminergic imaging and CSF biomarkers in PD patients. Compared to normal aging, PD was associated with higher rates of FA reduction, rD and aD increases predominantly in the substantia nigra, midbrain and thalamus. The highest rates of FA reduction involved the substantia nigra (3.6±1.4%/year from baseline, whereas the highest rates of increased diffusivity involved the thalamus (rD: 8.0±2.9%/year, aD: 4.0±1.5%/year). In PD patients, high DTI changes in the substantia nigra correlated with increasing dopaminergic deficits as well as with declining α-synuclein and total tau protein concentrations in cerebrospinal fluid. Increased DTI rates in the thalamus correlated with progressive decline in global cognition in PD. The results suggest that higher rates of regional microstructural degeneration are potential markers of PD progression.
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35
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White matter microstructural characteristics in newly diagnosed Parkinson's disease: An unbiased whole-brain study. Sci Rep 2016; 6:35601. [PMID: 27762307 PMCID: PMC5071859 DOI: 10.1038/srep35601] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/23/2016] [Indexed: 11/18/2022] Open
Abstract
Parkinson’s disease (PD) is a debilitating neurodegenerative disorder. Findings on specific white matter (WM) alterations in PD have been inconsistent. We hypothesized that WM changes occur in early PD patients and unbiased whole-brain analysis may provide additional evidence of pathological WM changes in PD. In this study, we examined various indexes of WM microstructure in newly diagnosed PD patients at the whole-brain level. 64 PDs with Hoehn & Yahr stage 1 (HY1PDs), 87 PDs with Hoehn & Yahr stage 2 (HYPD2s), and 60 controls (HCs) were recruited. Tract-based spatial statistics (TBSS) and diffusion connectometry were used to identify changes of WM pathways associated with PD. There were no significant differences in axial diffusivity, but HY1PDs exhibited greater fractional anisotropy (FA) and decreased mean and radial diffusivities (MD and RD) in callosal, projection, and association fibres than HCs and HY2PDs. Motor severity was inversely correlated with FA, but positively correlated with MD and RD in PD patients. Connectometry analysis also revealed increased WM density in the aforementioned tracts in PD patients, compared with HCs. Our study reveals WM enhancement, suggesting neural compensations in early PD. Longitudinal follow-up studies are warranted to identify the trajectory of WM changes alongside the progression of PD.
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Dean DC, Sojkova J, Hurley S, Kecskemeti S, Okonkwo O, Bendlin BB, Theisen F, Johnson SC, Alexander AL, Gallagher CL. Alterations of Myelin Content in Parkinson's Disease: A Cross-Sectional Neuroimaging Study. PLoS One 2016; 11:e0163774. [PMID: 27706215 PMCID: PMC5051727 DOI: 10.1371/journal.pone.0163774] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/14/2016] [Indexed: 12/11/2022] Open
Abstract
Alterations to myelin may be a core pathological feature of neurodegenerative diseases. Although white matter microstructural differences have been described in Parkinson's disease (PD), it is unknown whether such differences include alterations of the brain’s myelin content. Thus, the objective of the current study is to measure and compare brain myelin content between PD patients and age-matched controls. In this cross-sectional study, 63 participants from the Longitudinal MRI in Parkinson's Disease study underwent brain MRI, Unified Parkinson's Disease Rating Scale (UPDRS) scoring, and cognitive asessments. Subjects were imaged with the mcDEPSOT (multi-component driven equilibrium single pulse observation of T1 and T2), a multicomponent relaxometry technique that quantifies longitudinal and transverse relaxation rates (R1 and R2, respectively) and the myelin water fraction (VFM), a surrogate for myelin content. A voxel-wise approach was used to compare R1, R2, and VFM measures between PD and control groups, and to evaluate relationships with age as well as disease duration, UPDRS scores, and daily levodopa equivalent dose. PD subjects had higher VFM than controls in frontal and temporal white matter and bilateral thalamus. Greater age was strongly associated with lower VFM in both groups, while an age-by-group interaction suggested a slower rate of VFM decline in the left putamen with aging in PD. Within the PD group, measures of disease severity, including UPDRS, daily levodopa equivalent dose, and disease duration, were observed to be related with myelin content in diffuse brain regions. The age-by-group interaction suggests that either PD or dopaminergic therapies allay observed age-related myelin changes. The relationships between VFM and disease severity measures suggests that VFM may provide a surrogate marker for microstructural changes related to Parkinson’s disease.
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Affiliation(s)
- Douglas C Dean
- Waisman Center, University of Wisconsin Madison, Madison, Wisconsin, United States of America
| | - Jitka Sojkova
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America.,Department of Neurology, University of Wisconsin Madison, Madison, Wisconsin, United States of America
| | - Samuel Hurley
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Steven Kecskemeti
- Waisman Center, University of Wisconsin Madison, Madison, Wisconsin, United States of America
| | - Ozioma Okonkwo
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Barbara B Bendlin
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Frances Theisen
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America.,Department of Neurology, University of Wisconsin Madison, Madison, Wisconsin, United States of America
| | - Sterling C Johnson
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Andrew L Alexander
- Waisman Center, University of Wisconsin Madison, Madison, Wisconsin, United States of America.,Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America.,Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Catherine L Gallagher
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America.,Department of Neurology, University of Wisconsin Madison, Madison, Wisconsin, United States of America.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
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Hirata FCC, Sato JR, Vieira G, Lucato LT, Leite CC, Bor-Seng-Shu E, Pastorello BF, Otaduy MCG, Chaim KT, Campanholo KR, Novaes NP, Melo LM, Gonçalves MR, do Nascimento FBP, Teixeira MJ, Barbosa ER, Amaro E, Cardoso EF. Substantia nigra fractional anisotropy is not a diagnostic biomarker of Parkinson's disease: A diagnostic performance study and meta-analysis. Eur Radiol 2016; 27:2640-2648. [PMID: 27709279 DOI: 10.1007/s00330-016-4611-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/31/2016] [Accepted: 09/15/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Our goal was to estimate the diagnostic accuracy of substantia nigra fractional anisotropy (SN-FA) for Parkinson's disease (PD) diagnosis in a sample similar to the clinical setting, including patients with essential tremor (ET) and healthy controls (HC). We also performed a systematic review and meta-analysis to estimate mean change in SN-FA induced by PD and its diagnostic accuracy. METHODS Our sample consisted of 135 subjects: 72 PD, 21 ET and 42 HC. To address inter-scanner variability, two 3.0-T MRI scans were performed. MRI results of this sample were pooled into a meta-analysis that included 1,432 subjects (806 PD and 626 HC). A bivariate model was used to evaluate diagnostic accuracy measures. RESULTS In our sample, we did not observe a significant effect of disease on SN-FA and it was uninformative for diagnosis. The results of the meta-analysis estimated a 0.03 decrease in mean SN-FA in PD relative to HC (CI: 0.01-0.05). However, the discriminatory capability of SN-FA to diagnose PD was low: pooled sensitivity and specificity were 72 % (CI: 68-75) and 63 % (CI: 58-70), respectively. There was high heterogeneity between studies (I2 = 91.9 %). CONCLUSIONS SN-FA cannot be used as an isolated measure to diagnose PD. KEY POINTS • SN-FA appears insufficiently sensitive and specific to diagnose PD. • Radiologists must be careful when translating mean group results to clinical practice. • Imaging protocol and analysis standardization is necessary for developing reproducible quantitative biomarkers.
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Affiliation(s)
- Fabiana C C Hirata
- LIM-44, Department of Radiology, University of São Paulo, Rua Oscar Freire, 1967, Apto. 43A, Cerqueira César, São Paulo, SP, Brazil
| | - João R Sato
- LIM-44, Department of Radiology, University of São Paulo, Rua Oscar Freire, 1967, Apto. 43A, Cerqueira César, São Paulo, SP, Brazil
- Center of Mathematics, Computation and Cognition, Universidade Federal do ABC, Santo André, Brazil
| | - Gilson Vieira
- LIM-44, Department of Radiology, University of São Paulo, Rua Oscar Freire, 1967, Apto. 43A, Cerqueira César, São Paulo, SP, Brazil
| | - Leandro T Lucato
- LIM-44, Department of Radiology, University of São Paulo, Rua Oscar Freire, 1967, Apto. 43A, Cerqueira César, São Paulo, SP, Brazil
| | - Claudia C Leite
- LIM-44, Department of Radiology, University of São Paulo, Rua Oscar Freire, 1967, Apto. 43A, Cerqueira César, São Paulo, SP, Brazil
| | - Edson Bor-Seng-Shu
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Bruno F Pastorello
- LIM-44, Department of Radiology, University of São Paulo, Rua Oscar Freire, 1967, Apto. 43A, Cerqueira César, São Paulo, SP, Brazil
| | - Maria C G Otaduy
- LIM-44, Department of Radiology, University of São Paulo, Rua Oscar Freire, 1967, Apto. 43A, Cerqueira César, São Paulo, SP, Brazil
| | - Khallil T Chaim
- LIM-44, Department of Radiology, University of São Paulo, Rua Oscar Freire, 1967, Apto. 43A, Cerqueira César, São Paulo, SP, Brazil
| | - Kenia R Campanholo
- LIM-44, Department of Radiology, University of São Paulo, Rua Oscar Freire, 1967, Apto. 43A, Cerqueira César, São Paulo, SP, Brazil
| | - Natalia P Novaes
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Neurology, University of São Paulo, São Paulo, Brazil
| | | | | | - Felipe Barjud Pereira do Nascimento
- LIM-44, Department of Radiology, University of São Paulo, Rua Oscar Freire, 1967, Apto. 43A, Cerqueira César, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Edson Amaro
- LIM-44, Department of Radiology, University of São Paulo, Rua Oscar Freire, 1967, Apto. 43A, Cerqueira César, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Ellison Fernando Cardoso
- LIM-44, Department of Radiology, University of São Paulo, Rua Oscar Freire, 1967, Apto. 43A, Cerqueira César, São Paulo, SP, Brazil.
- Hospital Israelita Albert Einstein, São Paulo, Brazil.
- Institute of Mathematics and Statistics University of São Paulo (IME-USP), São Paulo, Brazil.
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Tuite P. Magnetic resonance imaging as a potential biomarker for Parkinson's disease. Transl Res 2016; 175:4-16. [PMID: 26763585 DOI: 10.1016/j.trsl.2015.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 01/01/2023]
Abstract
Although a magnetic resonance imaging (MRI) biomarker for Parkinson's disease (PD) remains an unfulfilled objective, there have been numerous developments in MRI methodology and some of these have shown promise for PD. With funding from the National Institutes of Health and the Michael J Fox Foundation there will be further validation of structural, diffusion-based, and iron-focused MRI methods as possible biomarkers for PD. In this review, these methods and other strategies such as neurochemical and metabolic MRI have been covered. One of the challenges in establishing a biomarker is in the selection of individuals as PD is a heterogeneous disease with varying clinical features, different etiologies, and a range of pathologic changes. Additionally, longitudinal studies are needed of individuals with clinically diagnosed PD and cohorts of individuals who are at great risk for developing PD to validate methods. Ultimately an MRI biomarker will be useful in the diagnosis of PD, predicting the course of PD, providing a means to track its course, and provide an approach to select and monitor treatments.
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Affiliation(s)
- Paul Tuite
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota.
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39
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Progression of Microstructural Degeneration in Progressive Supranuclear Palsy and Corticobasal Syndrome: A Longitudinal Diffusion Tensor Imaging Study. PLoS One 2016; 11:e0157218. [PMID: 27310132 PMCID: PMC4911077 DOI: 10.1371/journal.pone.0157218] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/26/2016] [Indexed: 11/19/2022] Open
Abstract
Progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) are both 4 microtubule binding repeat tauopathy related disorders. Clinical trials need new biomarkers to assess the effectiveness of tau-directed therapies. This study investigated the regional distribution of longitudinal diffusion tensor imaging changes, measured by fractional anisotropy, radial and axial diffusivity over 6 months median interval, in 23 normal control subjects, 35 patients with PSP, and 25 patients with CBS. A mixed-effects framework was used to test longitudinal changes within and between groups. Correlations between changes in diffusion variables and clinical progression were also tested. The study found that over a 6 month period and compared to controls, the most prominent changes in PSP were up to 3±1% higher rates of FA reduction predominantly in superior cerebellar peduncles, and up to 18±6% higher rates of diffusivity increases in caudate nuclei. The most prominent changes in CBS compared to controls were up to 4±1% higher rates of anisotropy reduction and 18±6% higher rates of diffusivity increase in basal ganglia and widespread white matter regions. Compared to PSP, CBS was mainly associated with up to 3±1% greater rates of anisotropy reduction around the central sulci, and 11±3% greater rates of diffusivity increase in superior fronto-occipital fascicules. Rates of diffusivity increases in the superior cerebellar peduncle correlated with rates of ocular motor decline in PSP patients. This study demonstrated that longitudinal diffusion tensor imaging measurement is a promising surrogate marker of disease progression in PSP and CBS over a relatively short period.
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Nagae LM, Honce JM, Tanabe J, Shelton E, Sillau SH, Berman BD. Microstructural Changes within the Basal Ganglia Differ between Parkinson Disease Subtypes. Front Neuroanat 2016; 10:17. [PMID: 26941615 PMCID: PMC4763054 DOI: 10.3389/fnana.2016.00017] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/08/2016] [Indexed: 11/13/2022] Open
Abstract
Diffusion tensor imaging (DTI) of the substantia nigra has shown promise in detecting and quantifying neurodegeneration in Parkinson disease (PD). It remains unknown, however, whether differences in microstructural changes within the basal ganglia underlie PD motor subtypes. We investigated microstructural changes within the basal ganglia of mild to moderately affected PD patients using DTI and sought to determine if microstructural changes differ between the tremor dominant (TD) and postural instability/gait difficulty (PIGD) subtypes. Fractional anisotropy, mean diffusivity, radial, and axial diffusivity were obtained from bilateral caudate, putamen, globus pallidus, and substantia nigra of 21 PD patients (12 TD and 9 PIGD) and 20 age-matched healthy controls. T-tests and ANOVA methods were used to compare PD patients, subtypes, and controls, and Spearman correlations tested for relationships between DTI and clinical measures. We found our cohort of PD patients had reduced fractional anisotropy within the substantia nigra and increased mean and radial diffusivity within the substantia nigra and globus pallidus compared to controls, and that changes within those structures were largely driven by the PIGD subtype. Across all PD patients fractional anisotropy within the substantia nigra correlated with disease stage, while in PIGD patients increased diffusivity within the globus pallidus correlated with disease stage and motor severity. We conclude that PIGD patients have more severely affected microstructural changes within the substantia nigra compared to TD, and that microstructural changes within the globus pallidus may be particularly relevant for the manifestation of the PIGD subtype.
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Affiliation(s)
- Lidia M Nagae
- Department of Radiology, University of Colorado Anschutz Medial Campus Aurora, CO, USA
| | - Justin M Honce
- Department of Radiology, University of Colorado Anschutz Medial Campus Aurora, CO, USA
| | - Jody Tanabe
- Department of Radiology, University of Colorado Anschutz Medial Campus Aurora, CO, USA
| | - Erika Shelton
- Department of Neurology, University of Colorado Anschutz Medial Campus Aurora, CO, USA
| | - Stefan H Sillau
- Department of Neurology, University of Colorado Anschutz Medial Campus Aurora, CO, USA
| | - Brian D Berman
- Department of Radiology, University of Colorado Anschutz Medial CampusAurora, CO, USA; Department of Neurology, University of Colorado Anschutz Medial CampusAurora, CO, USA; Neurology Section, Denver VA Medical CenterDenver, CO, USA
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41
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Planetta PJ, Ofori E, Pasternak O, Burciu RG, Shukla P, DeSimone JC, Okun MS, McFarland NR, Vaillancourt DE. Free-water imaging in Parkinson's disease and atypical parkinsonism. Brain 2015; 139:495-508. [PMID: 26705348 DOI: 10.1093/brain/awv361] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/26/2015] [Indexed: 12/11/2022] Open
Abstract
Conventional single tensor diffusion analysis models have provided mixed findings in the substantia nigra of Parkinson's disease, but recent work using a bi-tensor analysis model has shown more promising results. Using a bi-tensor model, free-water values were found to be increased in the posterior substantia nigra of Parkinson's disease compared with controls at a single site and in a multi-site cohort. Further, free-water increased longitudinally over 1 year in the posterior substantia nigra of Parkinson's disease. Here, we test the hypothesis that other parkinsonian disorders such as multiple system atrophy and progressive supranuclear palsy have elevated free-water in the substantia nigra. Equally important, however, is whether the bi-tensor diffusion model is able to detect alterations in other brain regions beyond the substantia nigra in Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy and to accurately distinguish between these diseases. Free-water and free-water-corrected fractional anisotropy maps were compared across 72 individuals in the basal ganglia, midbrain, thalamus, dentate nucleus, cerebellar peduncles, cerebellar vermis and lobules V and VI, and corpus callosum. Compared with controls, free-water was increased in the anterior and posterior substantia nigra of Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy. Despite no other changes in Parkinson's disease, we observed elevated free-water in all regions except the dentate nucleus, subthalamic nucleus, and corpus callosum of multiple system atrophy, and in all regions examined for progressive supranuclear palsy. Compared with controls, free-water-corrected fractional anisotropy values were increased for multiple system atrophy in the putamen and caudate, and increased for progressive supranuclear palsy in the putamen, caudate, thalamus, and vermis, and decreased in the superior cerebellar peduncle and corpus callosum. For all disease group comparisons, the support vector machine 10-fold cross-validation area under the curve was between 0.93-1.00 and there was high sensitivity and specificity. The regions and diffusion measures selected by the model varied across comparisons and are consistent with pathological studies. In conclusion, the current study used a novel bi-tensor diffusion analysis model to indicate that all forms of parkinsonism had elevated free-water in the substantia nigra. Beyond the substantia nigra, both multiple system atrophy and progressive supranuclear palsy, but not Parkinson's disease, showed a broad network of elevated free-water and altered free-water corrected fractional anisotropy that included the basal ganglia, thalamus, and cerebellum. These findings may be helpful in the differential diagnosis of parkinsonian disorders, and thereby facilitate the development and assessment of targeted therapies.
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Affiliation(s)
- Peggy J Planetta
- 1 Department of Applied Physiology and Kinesiology, University of Florida, USA
| | - Edward Ofori
- 1 Department of Applied Physiology and Kinesiology, University of Florida, USA
| | - Ofer Pasternak
- 2 Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Roxana G Burciu
- 1 Department of Applied Physiology and Kinesiology, University of Florida, USA
| | - Priyank Shukla
- 1 Department of Applied Physiology and Kinesiology, University of Florida, USA
| | - Jesse C DeSimone
- 1 Department of Applied Physiology and Kinesiology, University of Florida, USA
| | - Michael S Okun
- 3 Center for Movement Disorders and Neurorestoration, University of Florida, USA 4 Department of Neurology, University of Florida, USA 5 Department of Neurosurgery, University of Florida, USA
| | - Nikolaus R McFarland
- 3 Center for Movement Disorders and Neurorestoration, University of Florida, USA 4 Department of Neurology, University of Florida, USA
| | - David E Vaillancourt
- 1 Department of Applied Physiology and Kinesiology, University of Florida, USA 4 Department of Neurology, University of Florida, USA 6 Department of Biomedical Engineering, University of Florida, USA
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Chen Y, Pressman P, Simuni T, Parrish TB, Gitelman DR. Effects of acute levodopa challenge on resting cerebral blood flow in Parkinson's Disease patients assessed using pseudo-continuous arterial spin labeling. PeerJ 2015; 3:e1381. [PMID: 26734502 PMCID: PMC4699782 DOI: 10.7717/peerj.1381] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/14/2015] [Indexed: 01/20/2023] Open
Abstract
Introduction. Levodopa is the gold-standard for treatment of Parkinson’s disease (PD) related motor symptoms. In this study, we used pseudo-continuous arterial spin labeling (pCASL) to quantify changes in cerebral blood flow (CBF) after acute oral administration of levodopa in PD patients. Materials and Methods. Thirteen patients (3 females, age 66.2 ± 8.7 years) with moderately advanced PD (Hoehn and Yahr stage >2 (median 2.5), disease duration >3 years) were scanned on a 3T Siemens MR scanner before and after oral levodopa administration. Statistical parametric mapping was used to detect drug-induced changes in CBF and its correlation to clinical severity scales. Images were normalized and flipped in order to examine effects on the more affected (left) and less affected (right) cerebral hemispheres across the cohort. Results. Levodopa did not change global CBF but increased regional CBF in dorsal midbrain, precuneus/cuneus, more affected inferior frontal pars opercularis and triangularis, bilateral pre- and postcentral gyri, more affected inferior parietal areas, as well as less affected putamen/globus pallidus by 27–74% (p < 0.05, FWE corrected for multiple comparisons). CBF change was negatively correlated with improvement in bradykinesia UPDRS-III subscore in the more affected precentral gyrus, and total predrug UPDRS-III score in the mid-cingulate region. Drug-induced CBF change in a widespread network of regions including parietal and postcentral areas was also negatively correlated with the predrug rigidity UPDRS-III subscore. Conclusion. These findings are in line with prior reports of abnormal activity in the nigrostriatal pathway of PD patients and demonstrate the feasibility of pCASL as a neuroimaging tool for investigating in vivo physiological effects of acute drug administration in PD.
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Affiliation(s)
- Yufen Chen
- Department of Radiology, Feinberg School of Medicine, Northwestern University , Chicago, IL , USA
| | - Peter Pressman
- Department of Neurology, Memory and Aging Center, University of California , San Francisco, CA , USA
| | - Tanya Simuni
- Department of Neurology, Feinberg School of Medicine, Northwestern University , Chicago, IL , USA
| | - Todd B Parrish
- Department of Radiology, Feinberg School of Medicine, Northwestern University , Chicago, IL , USA
| | - Darren R Gitelman
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, IL, USA; Department of Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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43
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Zhang Y, Wu IW, Buckley S, Coffey CS, Foster E, Mendick S, Seibyl J, Schuff N. Diffusion tensor imaging of the nigrostriatal fibers in Parkinson's disease. Mov Disord 2015; 30:1229-36. [PMID: 25920732 PMCID: PMC4418199 DOI: 10.1002/mds.26251] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/14/2015] [Accepted: 03/23/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is histopathologically characterized by the loss of dopamine neurons in the substantia nigra pars compacta. The depletion of these neurons is thought to reduce the dopaminergic function of the nigrostriatal pathway, as well as the neural fibers that link the substantia nigra to the striatum (putamen and caudate), causing a dysregulation in striatal activity that ultimately leads to lack of movement control. Based on diffusion tensor imaging, visualizing this pathway and measuring alterations of the fiber integrity remain challenging. The objectives were to 1) develop a diffusion tensor tractography protocol for reliably tracking the nigrostriatal fibers on multicenter data; 2) test whether the integrities measured by diffusion tensor imaging of the nigrostriatal fibers are abnormal in PD; and 3) test whether abnormal integrities of the nigrostriatal fibers in PD patients are associated with the severity of motor disability and putaminal dopamine binding ratios. METHODS Diffusion tensor tractography was performed on 50 drug-naïve PD patients and 27 healthy control subjects from the international multicenter Parkinson's Progression Marker Initiative. RESULTS Tractography consistently detected the nigrostriatal fibers, yielding reliable diffusion measures. Fractional anisotropy, along with radial and axial diffusivity of the nigrostriatal tract, showed systematic abnormalities in patients. In addition, variations in fractional anisotropy and radial diffusivity of the nigrostriatal tract were associated with the degree of motor deficits in PD patients. CONCLUSION Taken together, the findings imply that the diffusion tensor imaging characteristic of the nigrostriatal tract is potentially an index for detecting and staging of early PD.
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Affiliation(s)
- Yu Zhang
- Center for Imaging of Neurodegenerative Diseases, San Francisco VA Medical Center, San Francisco, CA, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - I-Wei Wu
- Center for Imaging of Neurodegenerative Diseases, San Francisco VA Medical Center, San Francisco, CA, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Shannon Buckley
- Center for Imaging of Neurodegenerative Diseases, San Francisco VA Medical Center, San Francisco, CA, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Christopher S. Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Eric Foster
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Susan Mendick
- Institute for Neurodegenerative Disorders (IND) and Molecular NeuroImaging, LLC (MNI), New Haven CT, USA
| | - John Seibyl
- Institute for Neurodegenerative Disorders (IND) and Molecular NeuroImaging, LLC (MNI), New Haven CT, USA
| | - Norbert Schuff
- Center for Imaging of Neurodegenerative Diseases, San Francisco VA Medical Center, San Francisco, CA, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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